PRE-REGISTRATION: ANGIO CLUB @MYLIVE 2018 (26 JULY 2018 | 6:45pm - 8:30pm)
REGISTRATION FOR THIS EVENT IS CLOSED.
Full Name (required for CPD points)
NRIC (complete NRIC required for CPD points)
Contact Number (Mobile)
Paramedic / Allied Health
Hospital / Institution
NHAM Membership Status
NHAM Member - FREE ADMISSION (membership fee must be up-to-date)
**NON-NHAM Member - RM 100 ADMISSION FEE
ICSM Membership Status
CONFIRMATION OF REGISTRATION
A confirmation email will be sent to you to confirm your registration for the above.
**NON-NHAM Member - Secretariat will email to advise on payment. Payment is accepted via JomPAY & cheque deposit before 20 JULY 2018. A confirmation email will be sent to you once we receive the full payment.
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service