Pharmacyonline: Membership Registration

MEMBERSHIP REGISTRATION

Membership
- Membership benefits include:

discount on selected items upto 40%
rebate on shipping and handling (5 to 10%)
regular e-mail updates on health news and promotional items.
- An annual membership fee of RM 10.00 (Malaysians) or USD 6.00 (International customers) is payable every year on 1st January.
* Secure online transaction will be in USD (RM 10 = USD 2.65)

Please fill in the following information for enquiry.
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Terms and Conditions:
*Please read the terms & conditions .
I have read the terms and conditions and agree by them.

**Name:
**Age:
**IC/License Driving:
**Address:
**City:
**State:
**Country:
**Zip:
**Email:
Phone:
Fax: