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Registration Form (LOCAL): 2nd Regional Symposium on Nutrition & Healthy Longevity 
August 26, 2026 | M World Hotel Petaling Jaya, Malaysia
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Please take some time to read through the below before filling out the registration form:
* If the invoice is to be billed to the registrant, please note that the information entered in the registration form will be reflected on the invoice.
* If the invoice is to be billed to a company or organization, please complete the section titled “Organization/Company Billing Details” at the end of the registration form.
* An invoice will be issued to all participants for payment of the registration fee.
* Registration will only be confirmed upon receipt of full payment. Kindly email the proof of payment after the payment has been made.
* For companies registering multiple participants, please submit a separate registration form for each participant. 
Participant Personal Information
Prefix *
First Name/ Given Name *
Last Name/ Surname *
Name of Organization/ Company *
Department *
Job Title *
Address *
Email Address *
Contact Number *
Please include your country code and area code.
Registration Fee Payment Information
Please select Participant Category *
Mode of Payment  *
Please select the mode of payment.
**You do not need to make any payment now. We will issue you an invoice with the payment details when we have verified your registration.**
NOTE:

Once you or your company has completed the payment, please email us a copy of the bank deposit slip or payment transfer confirmation for our records.

Will you be applying to claim for HRDF? *
Is the invoice billed to the Registrant? *
Dietary Requirements E.g. Vegetarian  *
Remarks if any
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