PSDM Membership Application Form

Conditions & Instructions of Application

Application as PSDM members is open to Malaysian citizens aged 18 years and above.

Please fill in CAPITAL LETTERS. Your application will not be processed if information provided is incomplete.

Please attach 1 copy each of the following cards (front and back) together with your application :-
1. Applicant’s Identity Card
2. D.S.’s Identity Card
3. OKU Card

Wherever it appears in this application form D.S. shall mean Down Syndrome children. PSDM shall mean Down Syndrome Association of Malaysia.

All information marked * are mandatory

Applicant

Spouse

D.S.

Fees

(I) Details of Applicant

Name as per NRIC*

NRIC No.

Copy of NRIC No file chosen

Date of Birth

Age

Gender

Male

Female

Occupation

Address

Postcode

State

Handphone No.*

Email*

House Tel. No.

Office Tel. No.

If your application is successful, can you participate in the PSDM voluntary programme?

Select

Yes, I can

No, I cannot

If your above answer is YES, please state briefly your experience and expertise in areas where you can contribute

(II) Details of Spouse

Name as per NRIC

NRIC No.

Date of Birth

Age

Gender

Male

Female

Occupation

Handphone No.

(III) Details of Individual with Down Syndrome

Name as per NRIC

NRIC No. (If applicable)

OKU Card No.

Copy of NRIC (if applicable) No file chosen

Copy of OKU Card No file chosen

Date of Birth

Age

Gender

Male

Female

Relationship with Applicant

Sibling's position

Child Health Condition

(IV) Membership Fees

Registration fees for new PSDM membership: RM20.00.
Kindly make payment directly to:

Bank: Maybank Islamic
Name : Persatuan Sindrom Down Malaysia
Acct No: 564427306431

I upload herewith the payment slip for RM20.00 for entry fee* No file chosen

Types of Membership: To be paid after application is approved.

Form A - Life Membership RM150.00 one time only
Form A - Down Syndrome individual only RM30.00 one time only
Form B - Associated Member RM100.00 annually
Form C - Affiliated Member RM50 annually

Declaration by Applicant*

I hereby declare that the above information given is true to the best of my knowledge. I agree that any false information given will render my application being rejected. I undertake to inform the Association on any change of the particulars. I will abide by the rules of the Association upon acceptance of this application.

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PSDM Membership Application Form

Conditions & Instructions of Application

(I) Details of Applicant

(II) Details of Spouse

(III) Details of Individual with Down Syndrome

(IV) Membership Fees

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