MIC Membership Application

Direct Membership Application Form

Please fill out all required fields to complete your membership application

Full Name as per IC *

IC Number *

Email Address *

Phone Number *

Date of Birth *

Religion *

Address *

City *

State*

Postcode *

State *

Parliament

DUN

MYKAD IC (Front) * Upload a clear image of the front of your MYKAD IC (Max 5MB)

MYKAD IC (Back) * Upload a clear image of the back of your MYKAD IC (Max 5MB)

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