APPLICATION FOR MEMBERSHIP
Personal Data
Name: Prof./Dr./Mr./Mrs./Miss (Full name)...... ………………………………..………………………
NRIC No.: ...... Citizenship:………………………………..…….………………
Address (Postal):...... ……………………………...... ……………………………......
...... ……………………………...... ……………………………......
Address (Work): ...... …………………………….……………………………......
...... …………………………………………………………......
Contact: Tel: ...... …………………. Fax: ....……………....…...... E-mail: ...... …………………………………………………….
Educational Qualifications / Name of Degree / University/Body / Graduation YearBasic degree
Masters degree
PhD
Professional/Postgraduate/Other
Present Appointment as: ...... ……………...... ………...... Since (Year): ....……......
Duties and Responsibilities: …………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………………
Previous Appointments (inc. employers & service years/period. Please also send us your CV later): ......
I wish to apply for Ordinary/Associate/Retired membership to the Malaysian Association of Clinical Biochemists and agree to abide by its Constitution and Bylaws and to support its objectives.
PROPOSERS
We, as members of the Malaysian Association of Clinical Biochemists with personal knowledge of the applicant, wish to support his/her application for membership of the Association.
Name of Member (Proposer): ...... ……………….……...... Signature: ...... Date: …………..………………
Name of Member (Seconder): ...... ……….………...... …. Signature: ...... Date: ………….……….………
PAYMENT
I enclose Cash/Cheque/Postal Order No. ______for RM______being payment for the above.
Date: ...... …………….. Signature: ......
FOR MACB USE ONLY
I. MEMBERSHIP APPROVAL
Admission as Ordinary/Associate/Retired Member of the Association approved/not approved by the Council.
Date of Council Meeting: ...... …...... …………………… Signature: ...……………………………………………. (Secretary)
II. PAYMENT
Amount received: RM ……………………………………… Cash/Cheque/Postal Order No: …………..….………………………….
Date received: …………………….…… Receipt no.: …………………... Signature: ……………………………………………. (Treasurer)
MEMBERSHIP FORM INSTRUCTIONS
Please fill in all particulars clearly in capital letters.
Personal data
It is important to include the current work address, phone numbers and e-mail address for correspondence purposes and to send announcements for meetings, training and conferences. Most correspondences will be by e-mail.
If possible, please include more than 1 phone number and e-mail such as office and personal.
Educational Qualifications
Fill in education background of applicant including the name of university and year of graduation for each.
Present Appointment: State current designation and appointment date.
Duties and responsibilities: Fill in current duties and responsibilities.
Previous Appointments:
List down all relevant previous appointments. Include place of employment and years.
Please use a separate sheet or at the bottom of this sheet if space in insufficient.
Proposer and Seconder:
Fill in the names of proposer and seconder.
Leave blank if you do not have a proposer and seconder.
Completed application should be sent to the Hon. Secretary or to any Council Member.
Curriculum Vitae:
Please send your CV as soon as possible to:
Payment:
All Cheques/Postal Orders to be crossed and made payable to:
“Malaysian Association of Clinical Biochemists”
Bank: Standard Chartered, Jalan Ipoh, Kuala Lumpur. Account No: 873-1-4640067-2.
Additional Information
- “Ordinary Member” shall be a person who is wholly or mainly occupied with the practice of clinical biochemistry, and has at least a two-year working experience in a recognised clinical laboratory, or in the case of a medical graduate, a relevant higher qualification, and has been admitted as “Ordinary Member” by the Council.
- “Associate Member” shall be a clinical biochemist or a medical graduate who has less than 2 years working experience in a clinical laboratory or a scientist or doctor practicing in other fields of pathology or clinical laboratory. An “Associate Member” is entitled to all the benefits and privileges of membership except that he shall not be eligible for membership of the Council and shall not be entitled to vote at any meeting of the Association or to nominate any member for election to any office or position in the Association.
- “Retired Member” shall be an “Ordinary Member” for at least 10 years, who has retired from full-time practice of clinical biochemistry and has applied for this category of membership, subject to approval by the Council. A “Retired Member” is entitled to all the benefits and privileges of membership. A one-time fee will be imposed.