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Online Registration
(
) Required information
Participant Particulars
Title
-Select-
Dr
Prof
Assoc. Prof
Dato'
Datuk
Datin
Mr
Mrs
Ms
Full Name
Mobile No.
Including country and area codes
Email
Medical Registration No.
Please include N/A if not available
NRIC No.
Do not include hypen for IC No. State N/A if not applicable
Passport No.
For non-Malaysian
Date of Birth
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Designation
-Please select-
Specialist
Medical officer/General Practitioner
Nurses, Sonographer, Paramedics
Medical Student
Nurse Trainer
Nurse
Designation
-Please select-
Specialist
Medical officer/General Practitioner
Nurses, Sonographer, Paramedics
Medical Student
Others
Department
Institution / Organisation
Correspondence Address
City
State
— Select State —
Johor
Kedah
Kelantan
Melaka
Negeri Sembilan
Pahang
Perak
Perlis
Pulau Pinang
Sabah
Sarawak
Selangor
Terengganu
W.Persekutuan (KL)
W.Persekutuan (LABUAN)
W.Persekutuan (PUTRAJAYA)
Others
Country
Covid-19 Vaccine
-Please select-
Yes
No
Have you completed both doses of Covid-19 vaccine?(*Only if interested in hands-on)
Office Telephone No.
(including country and area codes)
Fax No.
(including country and area codes)
Meal Preference
Vegetarian
Non-Vegetarian
Letter for Visa Application
Yes
No
Registration Details
Category
Lectures + Hands on session
RM 350
Preferred site for hands-on
-Please Select-
Hospital Umum Sarawak (-9 seats left)
Hospital Miri (6 seats left)
Hospital Sibu (8 seats left)
Hospital Bintulu (9 seats left)
Hospital Sarikei (2 seats left)
Hospital Umum Sarawak (Houseman ONLY) (1 seats left)
Mode of Payment
Proceed with online payment/ credit card via iPay88
Importance Notice:
iPay88 payment gateway does not accept Corporate / Business / AMEX / Commercial MASTER / VISA Credit Card type. Only personal credit cards are accepted for all online payments. Ipay88 transaction fee is borne by the participant.
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