New Member Application


The Honorary Secretary
Obstetrical and Gynaecological Society of Malaysia.

I would like to apply for membership of the Obstetrical and Gynaecological Society of Malaysia and agree to abide by its Rules & Constitution if my application for membership is approved.

* Membership is subject to the approval of the OGSM Council. If the application is unsuccessful, payments will be refunded in full.

» RM20 Per Year For Doctors Who Graduated Less Than Five Years Ago
» RM50 Per Year For Doctors Holding MRCOG/MOG Degrees or Those Who Graduated More than 5 Years Ago
» RM1000 for Life Membership
» RM20 (Entrance Fee, one-time Payment Only)

Title* :
(same as in I.C.)
New I.C. No.*
(Use this as the login username)
Passport No. :
Gender : Male Female
Nationality : Malaysian Others
Type of Practice* :

» Home Address

Address* :
City* :
State* :
Postcode* :
Country* :

» Office Address

Address* :
City :
State :
Postcode :
Country :

» Contact Information

Telephone (Mobile)* :
Telephone (Home) :
Telephone (Office) :
Fax No. :
Email* :
Preferred Mailing Address* : Home Office
Year Awarded*
Sub-specialty Interest :
Fertility & Sterility
Maternal-Fetal Medicine
Gynaecological Endoscopy
Gynaecological Oncology
Office Gynaecology
Proposer* :
Seconder* :
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