MARN Membership Form

SELECTED PUBLICATIONS

Note: Please list three (3) recently published papers, book chapters, books, or other reports that you have authored/ co-cuthored
Publication 1
Publication 2
Publication 3

BACKGROUND
Please write a short paragraph of background information about yourself, including your experience in ageing research and development
Area(s) of Expertise/ Specialization

CONFIRMATION
I would like to join Malaysian Ageing Research Network (MARN) and hereby agree to receive e-mail communications and other information/ promotional materials from the Secretariat. I understand that all the details provided in this form is strictly private and confidential, and the information will be entered into a database and stored securely in accordance to the Personal Data Protection Act 2010. The data provided will be used for the purposes of organizing, coordinating and administering R&D activities by the Malaysian Research Institute on Ageing (MyAgeing), UPM and will not be shared, disclosed or sold to third parties. All employees who have access to the database and the associated with the handling of the data obliged to respect the confidentiality of the information provided
Your Signature

Clear
Date

Day Month Year
Date

OTHER INFORMATION AND DECLARATIONS
I prefer to be contacted via

Mail E-mail Phone
I give permission for my name and preferred contact information to be shared with other registered members for networking purposes. I confirm that there is no potential conflict of interest as a result of my membership in the network.
Append a copy of your updated CV (include list of research projects and publications) together with passport-sized photograph

Browse Files

Cancel of
Your registration will be acknowledged via e-mail
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform