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Application For Membership
Persatuan Transplan Malaysia
(Malaysian Society of Transplantation)
c/o Department of Nephrology
Institute of Urology, Hospital Kuala Lumpur,
Jalan Pahang, 50586 Kuala Lumpur.
Tel: 603 - 2698 4882 Fax: 603 - 2691 6514
 
Please fill in the details below:
 
I wish to become a member of the Malaysian Society of Transplantation under the catergory of :
Ordinary Member (RM25/year) Associate Member (RM10/year)
Ordinary Life Member (RM200) Associate Life Member (RM50)
   
Name:
IC No. (New)
             (Old)
Date of Birth
Place of Birth
Citizenship
Race
Name in Chinese
   
Correspondence
Address
Tel No
Fax No
Email
Occupation
Address of Employer
Qualifications
(with dates)
Specialty