MALAYSIAN PHYSIOTHERAPY ASSOCIATION (MPA)

Student Membership Application

New MPA Membership Registration For Students. Already a student 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. EDUCATION DETAILS

Institute Name

Please Enter Institute Name.

Institute Sector

Please Select Institute Sector.

Education Level

Please Select Education Level.

Institute Address

Please Enter Institute Address.

Postcode

Please Enter Postcode.

Institute State

Please Enter Institute State.

Country

Please Select Country.

Student ID

Please Enter Student ID.

Graduation Year

Please Select Graduation Year.

3. ATTACHMENTS

Maximum file size: 3MB.
Photo: JPG / PNG only. Student ID: PDF only.

Recent Photo *

Please Upload Photo.

Student ID *

Please Upload Student ID.

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 Country.

Guardian name: