Sample Page Member Registration ACCOUNT DETAILS First Name * Last Name * Email * Phone * Identity Card (Without "-", e.g. 123456121234) * MMC Number PROFESSIONAL PROFILE Job Role/Profession * Pharmacist Doctor Nurse Dietitian Specialities * General Practitioner Allergist or Immunologist Anesthesiologist Cardiologist Dermatologist Endocrinologist Family Medicine Gastroenterologist Hematologist Infectious Disease Internal Medicine Nephrologist Neurologist Obstetrician & Gynaecologist Occupational Medicine Oncologist Ophtamologist Orthopaedics Otolaryngologist Pediatrician Psychiatrist Pulmonary Medicine Radiologist Rheumatologist Surgeon Urologist Others Workplace Type * Hospital - Private Hospital - Government Clinic - Government Clinic - Private Hospital Pharmacy - Government Hospital Pharmacy - Private Retail Pharmacy State * Johor Kedah Kelantan Melaka Negeri Sembilan Pahang Penang Perak Perlis Sabah Sarawak Selangor Terengganu WP Kuala Lumpur WP Labuan WP Putrajaya Brunei Workplace Name * By submitting this form, you are agreeing to share your personal information with Novartis. * I agree to share my personal information with Novartis Submit
