MALAYSIAN PHYSIOTHERAPY ASSOCIATION (MPA)

MPA Membership Application

New MPA Membership Registration For physiotherapists. Already a member? Please CLICK HERE to access member login page.

1. PERSONAL DETAILS

Full Name (As Per IC / Passport) *

Please Enter Name.

Nationality *

Please Select Nationality.

IC / Passport *

Please Enter IC / Passport.

Gender *

Please Select Gender.

Address *

Please Enter Address.

State *

Please Select State.

Postcode *

Please Enter Postcode.

Country *

Please Select Country.

Contact No *

Please Enter Contact No.

2. WORK DETAILS

Highest Education *

Please Select Highest Education Level.

Employment Status *

Please Select Employment Status.

Job Sector

Please Select Job Sector.

Organization *

Please Select Organization.

Company Name

Please Enter Company Name.

Office Address

Please Enter Company Address.

Postcode

Please Enter Postcode.

State

Please Enter State.

Country

Please Select Country.

Office No

Please Enter Office No.

3. ATTACHMENTS

Maximum file size: 3MB.
Photo: JPG / JPEG / PNG only. Certificate: PDF only. Employment Letter: PDF only.

Recent Photo *

Please Upload Photo.

Official Certificate (Physio) *

Please Upload Certificate.

Employment Letter (For international members)

Please Upload Employment Letter.

4. LOGIN DETAILS

Please avoid using Hotmail for registration.

Account Email *

Please Enter Account Email.

Please Enter Password

Confirm Password

Please confirm password

5. MEMBERSHIP & PAYMENT

Membership Type *

Please Select Membership Type.

Membership Duration

Please Select Membership Duration

Registration Fee

Membership Fee (per year)

Membership Fee (Total)

Grand Total

Payment Mode

Please Select Payment Mode.

Spouse name: