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SCAN Membership (New Annual)
11 July 2021
RM
30.00
Title
(Required)
Mr
Mdm
Ms
Dr
Other
Name (as per IC)
(Required)
or passport
I.C. / Passport No
(Required)
Date of Birth
(Required)
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Gender
(Required)
Male
Female
Marital Status
Home Address
(Required)
Street Address
Address Line 2
City
State
Postcode
Mailing Address is the same as above
Mailing Address is the same as above
Mailing Address
(Required)
Street Address
Address Line 2
City
State
Postcode
Home Tel No
Mobile Tel No
Office Tel No
Email
(Required)
Enter Email
Confirm Email
Consent
(Required)
I agree to the statement below
I hereby apply for Membership of the Pertubuhan Untuk Advokasi Dan Kesedaran Kanser Kuching and declare that I hereby agree to abide by the Constitution and Bye-Laws of SCAN
Date
(Required)
DD
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MM
1
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YYYY
2026
2025
2024
2023
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2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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1949
1948
1947
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1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Additional Information
Information in this section is not required for membership but will help us understand you the member more.
I am a
Cancer Patient / Survivor
Caregiver of a cancer patient
tick all that applies
Cancer Patient / Survivor Information
What Cancer were you diagnosed with?
What Stage was your cancer? (at diagnosis)
You can enter I don't remember or I don't know.
In what year were you diagnosed with cancer?
Are you currently under treatment?
Yes
No
Are you in remission?
Yes
No
Caregiver Information
What Cancer was the person you are caring for diagnosed with?
What Stage was their cancer? (at diagnosis)
You can enter I don't remember or I don't know.
In what year were they diagnosed with cancer?
Are they currently under treatment?
Yes
No
Other
Are they in remission?
Yes
No
Other
Membership
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SCAN Membership (Lifetime)
RM
110.00
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