Persatuan Kedoktoran Teknikal Malaysia Membership Application
To apply for membership please complete all questions.
Name
IC No.
*
Title (Dr./Assoc Prof./Prof.
Address (Home)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Institution Name.
Position.
Address (Work)
Street Address
Street Address Line 2
City
State
Zip Code
E-mail
Home Number
-
Area Code
Phone Number
HP Number
-
Area Code
Phone Number
Work Number
-
Area Code
Phone Number
Membership Type
Ordinary PhD/Ed.D Membership
Associate - Professional Membership (Ir, Sr etc)
Associate - PhD Student
Field of PhD/Professional Expertise
University/Professional Body
Year Graduated/Awarded
(For PhD Student, please enter "Not Yet")
Currently working/Last Place of working at Polytechnic or Community College
Please upload a copy of PhD/ Ir, Sr awarded letter or PhD student acceptance letter as a prove, based on the Membership type above.
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I agree to pay RM 150 (Registration + one time membership fee) to PERSATUAN KEDOKTORAN TEKNIKAL MALAYSIA. MAYBANK current account No. 569972064781. Please Whatsapp/Telegram the prove of the transaction to Dr. Rokimah 0124800026 (Secretary).
Please Tick
*
I hereby understand all the terms written in the "Perlembagaan Persatuan Kedoktoran Teknikal Malaysia" and want to apply as a member.
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