MDIA MEMBERSHIP APPLICATION FORM

MEMBERSHIP APPLICATION FORM
ABOUT MALAYSIA DENTAL INDUSTRY ASSOCIATION (MDIA) MDIA (formerly known as MDDA) is officially registered with Registrar of Society (ROS) on the 2 September 2015 by a group of dental dealers who are markedly passionate about the future of dental industry, grow to total of 88 members in 2021. MDIA is the sole national association representing suppliers of dental products & devices both industry (For dental clinics, laboratories & hospitals used) and consumer (For individual used such as tooth paste, etc) in Malaysia dental industry. MDIA started Malaysia International Dental Show (MIDS) in 23-25 September 2016, being the 5th edition in 2022, is the leading international show of its kind to be held in Malaysia and in the region, this time organized by both the dental school of university together with trade association, namely MAHSA University and MDIA. Find out more here: Malaysia International Dental Show Our member companies also play a vital & important role in providing oral healthcare professionals with essential education and training to ensure safe and effective use of modern technology of dental device.
TERMS AND CONDITIONS Membership application is only valid for companies:
1. Ordinary membership applicable to companies which main business in supplying and distributing, manufacturing or sales representatives of dental medical device products registered with Registrar of Company (SSM).
2. Associate membership applicable to all representatives of dental medical device manufacturers which are based in Malaysia but not registered with Registrar of Company (SSM) yet wish to support and provide service to the associations. Associate membership can also apply for Associate Life Membership. However Associate Memebrs (Ordinary or Lifetime) do not have voting rights and hold any position in the association. Application will only be processed if all informations and supporting documents required are submitted.
3. Successful applicant will only be accepted as member after fees payment is made. Successful applicant MUST appoint an individual as representative to attend all meetings and events organised by the association.
4. The representative MUST meet the following criterias: lowest position held in the company is Managerial level Malaysian citizen Aged 18 and above.
5. All membership applications will be submitted to the Secretary General who will present to the Board of Committee for approval.
6. Membership application is subject to the approval by MDIA Board of Committee. The Board of Committee reserves the right to reject any application without giving any reason. The Board of Committee has the right to suspend or terminate membership if it violates the constitution of the association and/or violate the policies set by the Board of Committee.
Membership Applied For*

LIFE MEMBERSHIP (RM3,000 ONE TIME FEE)ORDINARY MEMBERSHIP (RM300 / ANNUM & ENTRANCE FEE RM200)ASSOCIATE LIFE MEMBERSHIP (RM3,000 ONE TIME FEE)ASSOCIATE MEMBERSHIP (RM200/ANNUM & ENTRANCE FEE RM200)
Who refer you to MDIA?*

MDIA Committee MemberMDIA MemberDentistFrom Malaysia International Dental Show (MIDS)From MDIA Website and Social Media
COMPANY PARTICULARS

(USE CAPITAL LETTERS)
Company Name*
Company ROC Registration No. (old)*
Company ROC Registration No. (new)*
Business Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Telephone Number*

Area CodePhone Number
Fax No. (if any)

Area CodePhone Number
Email Address (Admin Email for future correspondences related to MDIA matters)*
example@example.com
GST No. (If any)
MOF Reg No. (if any)
CAB Certified Company Name (if any)
GDPMD Cert No. (if any)
EXPIRY DATE (GDPMD Cert)

MonthDayYear
Date
MDA Establishment License No.*
EXPIRY DATE (MDA Establishment License)*

MonthDayYear
Date
PERSON IN CHARGE PARTICULARS

(USE CAPITAL LETTERS)
Person In Charge Name*

First NameLast Name
Age*
Date Of Birth*

MonthDayYear
Date
MyKad No. *
eg. 001122-33-4455
Mobile No.*
Designation in The Company*
Share holder / owner of the company (tick where applicable)*

YESNO
SUPPORTING DOCUMENTS UPLOAD

PLEASE ENSURE THAT ALL DOCUMENTS ARE SCANNED COPIES WITH INFORMATION CLEARLY SHOWN.
Company Logo*

Cancelof
Form 24*

Cancelof
Form 49*

Cancelof
Memorandum of Article (M&A)*

Cancelof
APPLICANT MYKAD*

Cancelof
APPLICANT BUSINESS. CARD*

Cancelof
GDPMD CERT*

Cancelof
MDA ESTABLISHEMENT LICENSE*

Cancelof
Applicant's Signature

Clear
Date*

DayMonthYear
Date
Name in Block*
Company Stamp (Upload here)*

Cancelof
Should be Empty:

MEMBERSHIP APPLICATION FORM

COMPANY PARTICULARS

PERSON IN CHARGE PARTICULARS

SUPPORTING DOCUMENTS UPLOAD