Registration Form

MMLHS Membership Registration

IMPORTANT!!! Please read this before fill up the form. Fill up the form with the right information. Wrong details may effect your e-receipt and e-certificate being generated to you. Please understand the term of membership categories accordingly. Annual membership is valid for one year of membership only while the lifetime is for lifetime membership. No duplication or redundant registration needed for all categories.

SALUTATION*
FULL NAME
IDENTIFICATION CARD NUMBER/PASSPORT NUMBER*
EMAIL ADDRESS*
CONTACT NUMBER/MOBILE NUMBER*
POSITION/DESIGNATION*
INSTITUTION/COMPANY*
REGION*
Region of Workplace
CITIZENSHIP*
Membership Category*
Including management fee at RM10.00 per new application.
Total
RM 0.00
Email
This field is for validation purposes and should be left unchanged.