ENT SUMMIT 2020 DELEGATE REGISTRATION FORM
Welcome respected delegates, we are pleased to know of your interest to be a part of our ENT SUMMIT 2020. The meeting will be held in Royale Chulan Hotel Kuala Lumpur, Jalan Conlay Kuala Lumpur from 27 - 29 February 2020. You may refer to the attached table for the registration rates.

Early Bird Rate: Register AND pay by 31 January 2020.

NOTE:
1) all rates are inclusive of 3-days full admission to the conference, with daily lunch and coffee breaks,
2) accommodation is NOT inclusive,
3) on-site registration is NOT available.

For MY Delegates, we accept payment via online transfer or via cash/cheque deposit machine.

For International Delegates, we accept payment via telegraphic transfer or credit card. If you opt for credit card payment, please email the Secretariat for further instructions.

PAYEE / ACCOUNT NAME: PRINCE COURT MEDICAL CENTRE SDN BHD
ACCOUNT NO: 80-0106004-5
BANK: CIMB BANK
SWIFT CODE: CIBBMYKL

Please fill in the form below and provide payment proof to entsummitmalaysia@gmail.com (attn to Ms. Haz) in order for your registration to be confirmed.

We look forward to seeing you there!
Full Name & Title (this will be inserted in your e-cert) *
Your answer
Name to be printed on tag *
Your answer
Delegate's Specialty *
Your answer
Organisation/Hospital (please include state for MY Delegates & country for International Delegates) *
Your answer
IC Number for CME Points (or MY Delegates only, for International Delegates you may fill NIL) *
Your answer
Mobile Number *
Your answer
Email Address (please provide a working email address as we will be sending your e-cert to this) *
Your answer
I have made payment via *
Meal Preference *
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