NUTRITION SOCIETY OF MALAYSIA
MEMBER REGISTRATION FORM

Personal Details

Please select Title.
Please enter name.
Please Enter valid NRIC without -
Please select date of birth.
Please select gender.
Please enter valid email.
Please enter academic qualifications.
Please enter Areas of interest/research.
Please enter address.
Please enter Postcode.
Please enter City.
Please select State.
Please enter Country.
Please enter Mobile No.
Please select Nationality.
Career Details

Please enter Title.
Please enter Title.
Please enter Company Name / Organization.
Please select Title.
Please select Title.
Please enter City.
Please select Title.
Please enter office contact no.
Please enter valid compEmail.
Attachments

Please attach photo.
Only jpg @ jpeg @ png format supported.
Maximum file size 2MB only
Please attach First degree certificate.
Only jpg @ jpeg @ png @ pdf format supported.
Maximum file size 2MB only
Please attach Certificate.
Only jpg @ jpeg @ png @ pdf format supported.
Maximum file size 2MB only
Bank Details

Bank name Account name Account number
CIMB BANK BERHAD NUTRITION SOCIETY OF MALAYSIA 8002 – 1551 – 09
Membership & Payment

Please select membership type.
Please select payment method.
Please attach payment proof.
Only jpg @ jpeg @ png @ pdf format supported.
Maximum file size 2MB only
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