Obstetrical & Gynaecological Society of Malaysia

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.

RM100 Per Year For Doctors Who Graduated Less Than Five Years Ago
RM200 Per Year For Doctors Holding MRCOG/MOG Degrees or Those Who Graduated More than 5 Years Ago
RM2,000 for Life Membership
RM25 Entrance fee, one-time payment only

Particulars

Title

Name* (same as in I.C.)

IC. No. (Use this as the login username)

Passport No.

Type of Practice*

Gender Male Female

Nationality Malaysian Others

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

Qualifications

Degree*

Institution*

Year Awarded*

Sub-specialty Interest

	General
	Fertility & Sterility
	Maternal-Fetal Medicine
	Gynaecological Endoscopy
	Gynaecological Oncology
	Office Gynaecology
	Urogynaecology

Proposer*

Seconder*

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