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Online Registration
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) 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
Not relevant
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 only
RM 250
Preferred site for hands-on
No hands-on
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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