PERINTIS Login

Registration Form

Photo (<10MB .pdf,.jpg,.jpeg,.png,.gif,.bmp)

Name (Please include title eg. Prof/Assoc. Prof/Dr)

Email

Phone Number

Gender

Religion

Registration Form

Race

NRIC Number

- -

Nationality

Address

Country

State:

City

Postal Code

Occupation

Registration Form

Employer

Title/Position

Employer Address

Country

State:

City

Postal Code

Contribution:

Type of Membership:

Annual: RM30.00 (+ Registration Fee RM50.00) | Total: RM80.00

Lifetime: RM300.00 (+ Registration Fee RM50.00) | Total: RM350.00

Payment can be made to (direct bank in) Persatuan Saintis Muslim Malaysia 12092010033214 (Bank Islam Malaysia Bhd)

Payment Proof:(<10MB .pdf,.jpg,.jpeg,.png,.gif,.bmp)