A therapeutic system
Complements    conventional
   medicine
A proven science of    medicine
A holistic approach

* - Required Fields 1. I wish to enrol as a : *     Full Member* Registration Fee - RM100.00   Annual Fee - RM150.00   * I am a qualified in the field of Homeopathy with certification from a registered Homeopathy Institution and am a full-time Homeopathic practitioner in a registered Homeopathy Clinic.    Associate Member** Registration Fee - RM100.00   Annual Fee - RM70.00   ** I am a qualified in the field of Homeopathy with certification from a registered Homeopathy Institute. (No full-time Homeopathic practice required)   You can also apply your Membership using the Polycrest Members Form - PDF version. For the Corporate Membership Form for Polycrest, please kindly click here for the Polycrest Corporate Form - PDF version. 2. New Members Details   Name *  : NRIC No. *  : (e.g., 701213074011) Gender :  Male Female Date of Birth : Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   Year 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 Race :  Malay Chinese Indian  Others, please specify Mailing Address : Postcode : Town : State : Mailing Address Type :  Home Office Occupation : Office Tel. No. : House Tel. No. : Hand Phone No. : Email Address *  : Website URL : 3. Qualification(s) *** :  MCE STPM Diploma Degree  Others, please specify *** To enclose copies of certificate   Please provide details of your qualification :   4. Please state your reasons for wanting to become a POLYCREST Member :   5. Please state your experiences with Homeopathy Medicine :   6. Please provide us your spouse's or heir's name & contact information :   Name : NRIC No. : Address : Relationship : 7. Oath *    I pledge my oath below. I hereby commit to popularize and upgrade the standards of Homeopathy and not to be involved with other types of medical treatment during my practise and to obey rules and regulations set by the association. I shall to pay my annual membership fee renewal one (1) month before my yearly membership expires. I certify that the information that I have given above is true and accurate. I also know that if I deny or breach the above oath, my membership may be rescinded or cancelled without prejudice.