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Membership Application Form
Return to: MSA secretariat, c/o Academy of Medicine of Malaysia, G-1 Medical Academies of Malaysia, 210 Jalan Tun Razak, 50400 Kuala Lumpur
Email: secretariat@acadmed.my     http://www.msa.net.my     Fax: 603-2093 0900

Membership fees:
RM 75 (ordinary member), RM 50 (associate member), RM 1,000 (life member)


Title:
Dr. / Assoc. / Prof / Dato' / Tan Sri
Name:
NRIC (New):
NRIC (Old):
Race:
Nationality:
Sex: Male Female
Marital Status: Single Married Others
Work Address:
Work Town:
Work Postcode
Work State:
Work Phone:
Work Fax:
Home Address:
Home Town:
Home Postcode
Home State:
Home Phone:
Mobile Phone:
Mailing Address: Send to: Home address Work address
Email:
Practice Type: Government University Private
Practice Status: Trainee Specialist
Special Interest:
Qualifications:
1. Qualification:
  Institution:
  Year of Award:
     
2. Qualification:
  Institution:
  Year of Award:
     
3. Qualification:
  Institution:
  Year of Award:
Referees:
(compulsory;
Referee must
be a member
of the MSA)
1. Referees:
  Address:
  Position:
     
2. Referees:
  Address:
  Position:
     
3. Referees:
  Address:
  Position:
Verification Code


IMPORTANT NOTE

This membership application will have to be accompanied by the payment of annual subscription i.e. RM75.00 for specialists (Ordinary Membership) and RM50.00 for trainees (Associate Membership). You can also opt to be a life member by donating an amount of RM1,000 to the Society.

Payment can be made in the following manner:

  1. Via cheque issued in favour of "Malaysian Society of Anaesthesiologists" and send with the membership application to:
    Malaysian Society of Anaesthesiologists
    G-1, Medical Academies of Malaysia, 210, Jalan Tun Razak, 50400 Kuala Lumpur
    Tel: 03 4023 4700, 03 4025 4700, 03 4025 3700
    Fax: 03 4023 8100
     
  2. Via telegraphic transfer, cheque or cash payment to account:
    Name: Malaysian Society of Anaesthesiologists
    Name and address of bank: CIMB Bank Berhad, KL Main Branch, 11 Jalan Raja Laut, 50350 Kuala Lumpur
    Account No: 80-0021098-1
    Code: CIBBMYKL

    Please email a scanned copy of the bank slip to the secretariat.

Kindly note that the MSA Executive Committee will not consider your membership application if payment is not received.
 

 



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