Request edit access
Cytology Workshop
Date: 13 April 2019 (Saturday)
Time: 0830 - 1700
Venue: Lecture Hall, Level 5, Main Building, SEGi College Penang, Wisma Greenhall, 43, Green Hall, 10200 Penang.

Organiser: Malaysian Institute of Medical Laboratory Sciences (MIMLS)
Co-organiser: SEGi College Penang, Malaysian Society of Cytology (MSOC)

Registration Fee: MIMLS Member / MSOC Member / SEGi College Penang Lecturer (RM 150); Non-member (RM 200)

Maximum number of participants: 40

Email address *
Personal Details
Please complete the following form. Fill in the required information using CAPITAL LETTER. Fields marked with asterisk (*) are required.
Title / Salutation *
Full Name (in Capital Letter) *
Gender *
Institution *
Profession *
Address *
Contact Number (eg. +60123456789) *
Registration Fee *
If you are a member of MIMLS / MSOC, please indicate your membership number (eg. M0001 / F0001).
Dietary Restriction *
Method of Payment *
Registration is confirmed based on the payment received.
Cheque / postal order and LPO made payable to MIMLS
or
You may remit your payment directly to MIMLS’s Bank account:
Bank : Malayan Banking Berhad (Maybank)
Account No. : 014169424162
Swift Code : MBBEMYKL
Please scan your transaction slip and upload or e-mail to mimls@ymail.com then submit the original copy to the secretariat during registration at the workshop.
Transaction slip upload
Comments (if any)
Thank you for completing the details
Kindly email your proof of registration to mimls@ymail.com
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. - Terms of Service