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  • Student Membership Application

    Student Membership Application

Requirements for Student Membership

  1. The applicant should be gaining his / her professional education and training from a recognized education institution that holds accredited status with The Councils on Chiropractic Education International (CCEI) accrediting bodies:
    1.1 Council on Chiropractic Education Australasia (CCEA)
    1.2 Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards (CFCREAB)
    1.3 Council on Chiropractic Education United States of America (CCE)
    1.4 European Council in Chiropractic Education (ECCE)

Application Process and Fees

  1. All sections of this application form, including the declaration must be completed.
  2. Supporting documents to be submitted with a completed application form include:
    2.1 Recent passport size photograph.
    2.2 Photocopy of your identification document (Identification Card for Malaysians and Passport for non-Malaysians).
  3. Payment for the student fee of RM50.00 must be made at the time of lodging an application.
  4. Membership must be renewed annually before the end of December.
  5. Payment method:
    7.1 Cash deposit or online transfer to ACM CIMB Account
    7.1.1 Account Name : Persatuan Kiropraktik Malaysia
    7.1.2 CIMB Account No. : 8002360559
  6. For renewal and applications, the Association will only deal with the member / applicant directly; not with the company / employer.
  7. Details on the deposit / transaction slip should include:
    10.1 Amount of Deposit (RM) :
    10.2 Date of Deposit :
    10.3 Beneficiary Account No. :
    10.4 Cheque No. (only for cheque deposits) :
    10.5 Cheque Issuing Bank (only for cheque deposits) :
  8. These conditions may change with amendments in policies and regulations of the Association.
  1. Name (as per Identification Card or Passport)*
    Please type your full name.
  2. Nationality*
    Invalid Input
  3. Identification Card No.
    Invalid Input
  4. Passport No.
    Invalid Input
  5. Issuing Country*
    Invalid Input
  6. Date of Issue
    / / Invalid Input
  7. Date of Expiry
    / / Invalid Input
  8. Gender*
    Please specify your position in the company
  9. Date of Birth*
    / / Invalid Input
  10. Ethnicity
    Invalid Input
  11. Home Phone No.
    Invalid Input
  12. Mobile Phone No.*
    Invalid Input
  13. Office Phone No.
    Invalid Input
  14. Correspondence Address*
    Invalid Input

  16. Institution Name*
    Invalid Input
  17. Qualification*
    Invalid Input
  18. Current Year of Study*
    Invalid Input
  19. Expected Year of Graduation*
    Invalid Input
  20. Email*
    Invalid email address.
    Please provide the student email id.
  21. Re-enter Email*
    Invalid email address. Email address must be the same as above.
    You will be able to login to the site using this email as username after you will receive an activation link by email and after your account will be enabled by the administrator.
  22. Password*
    Invalid Input
  23. Repeat Password*
    Try the same password as above.
  24. Identification Document*
    Invalid Input
    Identification Card / Passport - PDF, maximum 5MB
  25. Passport Size Photo*
    Invalid Input
    PDF, maximum 5MB
  26. How would you like to pay your member fee?*
    Invalid Input
    to open a new window/tab to our secure online payment gateway at Billplz
  28. Please Upload Payment Proof*
    Invalid Input
    PDF, maximum 5MB

    I hereby apply for membership into the Association of Chiropractic Malaysia and agree to abide by the rules, bylaws, regulations, Code of Ethics, and Advertising guidelines adopted by the Association.

    I agree to uphold the principles of the Association, to assist in all ways to accomplish the Association’s objectives, and to pay and be liable for all dues and professional indemnity insurance premiums imposed by the Association in accordance with the Rules.

    I hereby declare that all the information that I have provided with this application is true. I understand that any misrepresentation of the information provided whether wilful or unintentional may result in my immediate dismissal from the Association of Chiropractic Malaysia and a formal report with recommendations to be made to relevant regulatory bodies.

  30. I sign the declaration above*
    You must agree with the declaration above.