AMRAS

Personal Particulars

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NRIC/Passport No.

Title

Full Name

Email Address

Date of Birth

Mobile No.

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Nationality

Profession & Qualification

Institution

Profession

MMC No.

For Malaysian only for MMA CPD purposes

NSR No.

Place of Work (Address)

Member of

What area do you want to learn & participate?

How would you like to participate or volunteer in AMRAS?

Do you have any formal training in the field of Gynae MIS, Robotics, ablation therapy?
(If yes, please specify the type and duration of training.)

Which area of Advanced Gynaecology Procedure would you like to get training in?

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Personal Particulars

Profession & Qualification