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Malaysian Pharmaceutical Society
Malaysian Pharmaceutical Society



Malaysian Academy of Pharmacy
Malaysian Academy of Pharmacy

 
CPD Application Form

* denotes mandatory field.

Subscription: Subsription rate per annum (1st Jan - 31st Dec)
Year: 2016 2017 2018
Non-MPS Member RM 84.80
MPS Member Free until further notice (please proceed to login)

CPD Option
I would like to be verified by the officer in *

Personal Data
Salutation: Mr. Mrs. Ms. Dr. Prof.
Awards: (Datuk/Dato'/Others)
Surname: *
Given Name: *
Pharmacist Reg No: *
NRIC: * - -
Handphone:
Company/Institution: *
Designation: *
Sector: *
Area of Interest:
Preferred Username: * (For Non-MPS Members)
Preferred Password: * (For Non-MPS Members)

Contact Data - (please key in both contact data)
Office* Address:
Town:
Postcode:
State:
Country:
Telephone: -
Fax: -
Email:
Home* Address:
Town:
Postcode:
State:
Country:
Telephone: -
Fax: -
Email:
Preferred Correspondence Address: Office Home

Qualification
Qualification *
University/College *
Year Qualified *

Payment Options - (please select either one only)
Cheque/PO Cheque/PO No:
Amount: (RM)
Credit/Charge Card Card No:
Amount: (RM)
Expiry Date: - (mm-yyyy)
Type: Visa
Amex
MasterCard
Diners


 
 

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