Online membership form under construction. |      We anticipate being ready in just few days.
 
SAHAMM MEMBERSHIP APPLICATION FORM
“Add Life to Years and Years to Life!”
 
PLEASE SUBMIT YOUR PAYMENT SLIP TO sahamm020212sec@gmail.com

1. REGISTRATION INFORMATION

(WRITTEN IN CAPITAL LETTERS) (Please fill in every detail)

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2. SAHAMM MEMBERSHIP (PLEASE CHOOSE ONE)

PLEASE CHOOSE ONE.

3. SUPPORTING DOCUMENT

(REQUIRED BEFORE FINAL APPROVAL BY THE EXCO, PLEASE ENCLOSE A COPY WITH THIS FORM)

o COPY OF CURRENT MEDICAL LICENSE & CURRENT YEAR PRACTICING CERTIFICATE (For Doctors)

o COPY OF STUDENT’S ID CARD (For Medical Students Only)

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4. MEMBERSHIP IN OTHER ASSOCIATION

5. HOW DID YOU HEAR ABOUT SAHAMM?

6. MEMBERSHIP FEE

Note: For Corporate Membership, a one-time sign-up fee (Membership fee) and the 1st year Annual fee will be required upon sign-up. All fees paid are non-refundable.

7. PAYMENT METHOD

i) MALAYSIANS: Online Transfer or by Cash / Cheque Deposit

ii) FOREIGNERS: Telegraphic Transfer or PayPal

BANK DETAILS:

Beneficiary Name: SAHAMM

Bank: Public Bank Berhad

Account No: 3-166-497-325

Swift Code: PBBEMYKL

Address: Mont Kiara Branch, 
1 & 3, Jalan Solaris 1, 
Solaris Mont Kiara, 
50480 Kuala Lumpur, Malaysia

8. HONOR/ATTESTATION STATEMENT