Welcome to PERINTIS student member registration form page. Student member registration is open for undergraduate students only.

To learn more about types of membership please visit the membership information page or use the link at the top: MEMBERSHIP -> Information.

This is NOT for PERINTIS website user registration. For PERINTIS user registration, please click here.

Instructions

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  1. Log in/Register with PERINTIS website (Recommended).
  2. Please fill in the form carefully.
  3. All labels with the asterisk (*) are required.
  4. Application will be processed after receiving proof of payment.
  5. Please attach a scanned copy (front and back) of your student identification card in the form, OR you may e-mail/mail the copy to PERINTIS email/mailing address. 
  6. For further inquiries please contact: info@perintis.org.my

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Please let us know once payment is made as per the instruction below:

Payment for membership can be made to (Direct Bank In):
Persatuan Saintis Muslim Malaysia
Account Number: 12092010033214  (Bank Islam Malaysia Bhd).

Please scan and email receipt or sms proof of payment to the treasurer:
drnorazan61@gmail.com or kindly call 019 250 2420.

Personal Information

 

Student Information

 

PERINTIS

 

Student Membership Fees

 

Document Attachment

 

Verification