Registration Form | Malaysian Association for Prosthodontics

Membership is open to all persons fulfilling the requirements of the membership categories.
Refer to the Registration Requirements/Fees for full details of the requirements.

MAP Membership Form

Name *
Email *
Gender
Nationality *
NRIC / Passport No. *
Profile Photo

Contact details

Correspondence Address *

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Phone

Fax

Qualification Details

Basic Dental Qualification/University/Year

Qualification

University

Year

Additional Dental Qualification/University/Year

Additional Dental Qualification

University

Year

Other Qualification/University/Year

Other Qualification

University

Year

Professional Degree **Please upload the required supporting documents Professional degree (All catogory except student) that you have indicated under the qualification details.

MDC Registration Number Malaysia Dental Council Registration Number

Year Registered

MDC Certificate (Borang7) *Please upload the required supporting documents (Life and Ordinary Member)

Additional supporting documents

Category of MAP Membership Applied for

Category **Find all the information you need about MAP's membership fees at Registration Requirements/Fees page

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.I would like to apply for membership of the MAP and the required membership fee and a copy of my professional degree / certificate is enclosed. I declare that the above information provided by me is true and correct and i have read, understood and accepted the criteria for membership as stated.

Verification

Please enter any two digits *Example: 12
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