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Borang Permohonan Keahlian (
Member Application Form
)
For information on LASAM membership:
https://lasam.org.my/membership/
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* Indicates required question
Email
*
Your email
Alamat emel alternatif (
Alternative email address
)
*
Your answer
Jenis Keahlian (
Membership Type
)
*
Please
click here
for information on types of LASAM membership.
Ahli Biasa (Ordinary Member)
Ahli Bersekutu (Associate Member)
Ahli Seumur Hidup (Life Member)
Pelajar (Student Member)
Nama Penuh (
Full Name
)
*
Mengikut kad pengenalan/pasport (
According to identification card/passport
)
Your answer
Gelaran (
Title
)
*
Mr./Ms./Dr./AP./Prof./Datuk/Dato'/Tan Sri
Your answer
Kewarganegaraan (
Nationality
)
*
Your answer
Nombor Kad Pengenalan (
NRIC number
)
*
Bukan warganegara Malaysia: nombor pasport (
Non-Malaysian:
Passport number
)
Your answer
Jantina (
Gender
)
*
Female
Male
Tarikh lahir (
Date of birth
)
*
MM
/
DD
/
YYYY
Nombor telefon bimbit (
Mobile phone number
)
*
Your answer
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