Membership Renewal FieldsetName *Email *Phone *Dental Practice Year of Renewal *Types of membership (price for a year) ORDINARY (RM80/year)ASSOCIATE (RM80/year)STUDENT (RM30/year)Membership Agreement *Personal data protection Act: MAP respects the privacy of individuals with regards to their personal data and is committed to protecting the privacy of our members. By signing this form, you agree to allow us to manage and verify your membership, send you our newsletter and to respond to requests. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
