REGISTRATION FORM

For Official Use

Date received:   Registration number:  

Personal Particulars

Title : Prof. Dr. Mr. Mrs. Ms.  
Full Name
(as per I.C./Passport):
Speciality :
Institution :
Address :
City : Postcode :
Country :
Tel : Fax :
Email :

 

Registration & Fees (Please Tick the Appropriate boxes)
Registration Fee On or before 1st April 2010: After 1st April 2010:
Doctor/Medical Officer RM 450 RM 500
Paramedic/Allied Health RM 150 RM 200
Pre-Congress: Fellows Course (20th May 2010) RM 100 RM 150


NOTE: You ONLY qualify for the cheaper payment if your payment is received before the stipulated date!