MASH MEMBERSHIP RENEWAL FORM

MASH MEMBERSHIP RENEWAL FORM (2022-2023)

NOTICE: Please fill in all questions to update your latest professional information to assist in MASH Membership housekeeping. Contact us at membership@mash.org.my if you need more information.
I consent to share my professional data in MASH public directory *

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Name *
Membership ID (please refer to your e-certificate) *
Eg: 10001SLP
Phone number *
Email *
example@example.com
Company name & address (You may include more than one) *
Type of clinical service *

Government Hospital Inpatient Government Hospital Outpatient Private Hospital Inpatient Private Hospital / Clinic / Centre Outpatient Home Therapy (House-call) Teletherapy
PAYMENT DETAILS

Please make payments to
PER PERTUTURAN BAHASA DAN PENDENGARAN

Maybank Berhad
5126 7930 1895
Renewal Fee

1 year (RM 80)
Payment Method

Cheque Deposit Online Transfer Cash Deposit
Attach Proof of Payment *

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MASH MEMBERSHIP RENEWAL FORM (2022-2023)