MyMFT 2024 Membership Application & Renewal Form

MEMBERSHIP CATEGORY

ANNOUNCEMENT!

Duration of Membership and Membership Renewal
The MyMFT membership runs on a calendar year starting from 1st January until 31st December of the year.

Application for NEW membership:

Application for a one-year new membership: Membership Approval Date till 31st December 2026.

Application for a two-year new membership: Membership Approval Date till 31st December 2027.

RENEWAL of membership:

Application for a one-year renewal : Renewal Date to 31st December 2026.

Application for a two-year renewal : Renewal Date to 31st December 2027.

Membership Categories and Fees for One (1) Year:

1. Clinical Member: RM150.00
2. Associate Member: RM130.00
3. Affiliate or Student Member: RM100.00

+ One-time Application fees: RM50.00 [for NEW member only]

For new members please include in the payment for:

1. One-time Application fee of RM50.00

2. Select your membership type

Direct Banking
Bank Name: Malayan Banking Berhad
Account Name: Pertubuhan Terapi Perkahwinan Dan Keluarga Malaysia
Account Number: 564191779649

A 2% processing fee is charged to refund requests.

NOTE: Please prepare all the necessary documents and payment slips before getting started with the application form.

If you have any questions in filling up this form, please email us at membership@mymft.org

NOTE: It is highly recommended that you refer to the MyMFT Membership Guidelines to ensure your membership eligibility.

Membership Type

1. Clinical Member

Credentialed mental health professional actively working with couples and families

2. Associate Member

Credentialed mental health professional NOT actively working with couples and families

3. Affiliate or Student Member

Not a mental health professional but interested in the field OR Master's degree student in the field of mental health

PERSONAL INFORMATION

Full Name (Include Designation e.g. Prof., Dr., Mr., Ms.)*

First NameLast Name

E-mail*

example@example.com

Type of Application*

If you are renewing your membership, are all the information the same from your last application?*

MyMFT Membership No.:*

ex. 23

MyMFT Membership Type*

Please select your membership type

Current Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

NRIC/Passport No.*

Current Phone Number*

Area CodePhone Number

Date of Birth*

If you are a mental health practitioner, you are currently practicing as a*

licensed and registered counsellorclinical psychologistpsychiatristothers

License Number (Kb, Pa)/MMC number/ Registration Number with MSCP/Other Licensing Body Out of Malaysia

e.g. Licensed & Registered Counsellor (KB, PA), Clinical Psychologist (MSCP 1234)

University Name (For Student Member Only)

Organization/Professional Website

Organization Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

DOCUMENT GUIDELINES

Copy of Your Malaysian IC or passport*

Updated Resume (PDF Format)*

Copies of Relevant Degree Certs or Transcripts (REQUIREMENTS for New Clinical, Associate and Student membership application)

Updated Licensing/Registration Document (REQUIREMENTS for both Renewal & New Clinical & Associate membership application) 1. Counselor - License from Lembaga Kaunselor Malaysia (LKM); 2. Psychiatrist - Annual Practicing Certificate from Malaysia Medical Council (MMC) and registration with National Specialist Register (NSR); 3. Clinical Psychologist - Certificate with Malaysian Allied Health Professions Council (MAHPC) and Malaysian Society of Clinical Psychology (MSCP); 4. Other licensing body out of Malaysia

Post Graduate Certificate Specializing in MFT (REQUIREMENTS for New Clinical, Associate and Student membership application)

Verification of Clinical Supervision and/or Clinical Practice in Marriage and Family Therapy (REQUIREMENTS for New Clinical, Associate and Student membership application)

Other Professional Memberships

ACADEMIC/CLINICAL REFERENCES (REQUIREMENTS for New Clinical, Associate and Student membership application)

Academic/Clinical Referrer 1

First NameLast Name

Profession

e.g. Licensed and Registered Counsellor

Professional Licensing Body

e.g. Lembaga Kaunselor Malaysia

Email

example@example.com

Current Phone Number

Area CodePhone Number

Academic/Clinical Referrer 2

First NameLast Name

Profession

e.g. Licensed and Registered Counsellor

Professional Licensing Body

e.g. Lembaga Kaunselor Malaysia

Email

example@example.com

Current Phone Number

Area CodePhone Number

SUPERVISOR'S INFORMATION: CLINICAL SUPERVISOR TRAINED IN MFT (REQUIREMENTS for New Clinical and Associate membership application)

Name of Supervisor

Email Address

Type of License of Supervisor

MEMBERSHIP FEES

Membership Type*

[New Member Only] One-time Application FeeFirst time applying for new members

50.00MYR

Clinical Member [1 Year] (Approval Date to 31st December 2026)(1-year membership)

150.00MYR

Associate Member [1 Year] (Approval Date to 31st December 2026)(1-year membership)

130.00MYR

Affiliate or Student Member [1 Year] (Approval Date to 31st December 2026)(1-year membership)

100.00MYR

Clinical Member [2 Year] (Approval Date to 31st December 2027)(2-year membership)

300.00MYR

Associate Member [2 Year] (Approval Date to 31st December 2027)(2-year membership)

260.00MYR

Affiliate or Student Member [2 Year] (Approval Date to 31st December 2027)(2-year membership)

200.00MYR

Total

0.00MYR

Proof of Payment*

BACKGROUND CHECK

Please answer the questions below honestly.

Disclaimer: The MyMFT Board reserves the right to reject your application should any documents or information provided be found to be falsified

Have you ever been convicted of a crime?*

YesNo

Have you ever been subjected to any professional disciplinary action?*

YesNo

Do you have any pending disciplinary action against you?*

YesNo

If you answered YES to any of the questions above, please provide appropriate information about the charges laid against you.

Please provide supporting documentation about the charges laid against you.

By clicking YES, I agree to give MyMFT full permission to send me MyMFT marketing or promotional materials for membership and events to my registered email. I understand that I can unsubscribe anytime.*

Yes

ACKNOWLEDGEMENT

By clicking on YES, I am agreeing that all information provided in this application is true and accurate.*

Yes

Signature*

Full Name and NRIC/Passport No.*

Full Name, 000000-00-0000

Date*

2026 MyMFT Membership Application Form