MPDPA NEW MEMBERSHIP REGISTRATION FORM
Dear Colleague,
Welcome on board!

We look forward to serving you as our Esteemed Member.
Our Membership is open for all Dental Private Practitioners' ( Malaysian citizen only) & Dental students.

To proceed with your registration, kindly fill and submit this google form.

Please make the necessary payment :
New Membership (one time Registration fee ) : RM150
Membership Renewal Fees : RM 100 (annually)
Dental Student Membership : RM 30.

Kindly make an online payment to : Malaysia Private Dental Practitioners Association ,
MAYBANK Account : 5641 2843 0729.

Do email us your proof of payment along with a copy of your APC ( Annual Practicing Certificate ) to : mpdpa1@gmail.com

Your E-Receipt will be sent to you at the contact details provided.

Thank You!
MALAYSIAN PRIVATE DENTAL PRACTITIONERS' ASSOCIATION.
FULL NAME AS PER YOUR NRIC *
MDC NUMBER : *
NRIC NUMBER (no dash - ) *
CLINIC ADDRESS ( FULL ADDRESS ) *
CLINIC PHONE NUMBER *
MOBILE NUMBER ( REACHABLE ON WHATSAPP) *
EMAIL ADDRESS *
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