Welcome to PERINTIS member registration form page.

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. 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

 

Employment Information

 

PERINTIS

 

Membership Fees

 

Verification