JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Reply Slip - IEM 64th Annual Dinner 2023
Tel: 03 - 7968 4001 / 4002
Fax: 03 - 7957 7678
Email:
annual-dinner@iem.org.my
Submit Before Friday, 30th June 2023
EVENT: 64TH ANNUAL DINNER & AWARDS NIGHT 2023
DATE:15TH JULY 2023, SUNDAY
VENUE: ONE WORLD HOTEL, PETALING JAYA, SELANGOR
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Number of Table.:
*
Your answer
We are pleased to purchase the table(s) as follows:
(Cast per Table / 10 seats)
*
Category of Tables: Diamond (RM20,888.00) *Close to VVIP Table
Category of Tables: Platinum (RM15,888.00) *Close to VIP Table
Category of Tables: Gold (RM5,888.00)
Category of Tables: Silver (RM3,888.00)
Category of Tables: Single Seat (RM588.00)
Other:
Required
Full Name (as per in IC):
*
Your answer
Designation:
*
Your answer
Organisation:
*
Your answer
Address:
*
Your answer
Contact No. (Office):
*
Your answer
Fax No.:
Your answer
Mobile No.;
*
Your answer
Number of Vegetarian Food (if needed)
Your answer
Mode of Payment
*
CHEQUE (We will send an invoice by email)
Bank Transfer to UOB 232-303-911-0 (Please email the bank confirmation to
suriani@iem.org.my
)
CREDIT CARD (Visa/Mastercard) ONLY
Next
Page 1 of 2
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms