Malaysian Society of Paediatric Anaesthesiologists (MSPA) Annual Membership Application Form(A) Benefits of Membership: (i) Discounted registration fee at all MSPA events. (10%) (B) Registration Instructions: (i) To register online, please fill in the form and submit. The form will be sent to the Secretariat for record. (C) Annual Membership fee: Ordinary member (Anaesthesiologists): RM100 Associate member (Medical officers and allied health): RM50 Automatic admission to Life Membership: (i) 5 consecutive payments of RM100 Ordinary member fee per year Or (ii) single payment of RM500 Please email the transaction receipt to Malaysian Society of Paediatric Anaesthesiologists (MSPA) email account (mspanaes@gmail.com) once telegraphic Transfer is done. Information on Telegraphic transfers Payment should be made to: Beneficiary Name: PERSATUAN PAKAR ANESTESIOLOGI PEDIATRIK MALAYSIA Account number: 80-0936078-3 Beneficiary Bank Name: CIMB BankFull Name *I.C. Number *0 / 12Contact Number (Home [H]/Office [O]/ HP):Home Address *Work Address *Current Institution *Present Appointment *PrivatePublicAnaesthetic ConsultantPaediatric Anaesthesia FellowAnaesthetic Master/FCAI TraineeMedical OfficerOtherPlease tick whichever applicablePresent Appointment (Others) *Others: Please SpecifyPaediatric Anaesthesia Fellowship training institution(s) *Paediatric Anaesthesia Fellowship year of training *1st year2nd year3rd year and aboveMaster or FCAI training institution(s) *Master or FCAI year of training *1st year2nd year3rd year4th year and abovePayment Method *Electronic Funds Transfer/ Online TransactionsBank DraftCashBank Transfer(Choose One)Membership Subscription *RM100 (Anaesthesiologists)RM50 (Medical Officer)RM500 (Life Membership)(Choose One) SUBMITPlease do not fill in this field.
