REGISTRATION : 18th ANNUAL SCIENTIFIC MEETING OF MALAYSIAN SECTION IADR & 20th ANNUAL GENERAL MEETING
Registration Secretariat address:
Malaysian Section IADR
c/o: Associate Professor Dr Raja Azman Raja Awang
School of Dental Sciences, Universiti Sains Malaysia, USM Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia. Tel: 09-7675808/5825 Email:
Full Name of Participant
(First middle LAST name)
Malaysian Section IADR membership number
(ignore if not a member)
Main IADR member number
(ignore if not a member)
Telephone number (mobile)
Do you require VEGETARIAN meal?
Presenter (Oral, 3-mins Pitching)
Local Organising Committee
Registration Fee is RM 250 for Member/Postgraduate, RM200 for Undergraduate, RM300 for Non-member, USD100 for International participant : Payment method
1) Make all Cheques, Bank Drafts and LO letter payable to IADR MALAYSIAN SECTION. 2) Online payment via ATM transaction / Bank transfer to CIMB BANK acc. 1265-0000-4220-51, IADR MALAYSIAN SECTION. ABA Swift Code: CIBBMYKL
Bank Cheque or Draft
Online payment (ATM or Bank transfer)
Letter of Local Purchase Order for Government agencies only
FOR LOC/INVITED GUESTS ONLY
TERMS AND CONDITIONS OF REGISTRATION
Please read all the terms and check all boxes when done.
It is the responsibility of the Participant to ensure the Organiser received the payment in full via the method described.
All payments MUST be made and confirmed by 15th March 2019. Registration is not complete until payment is received.
Participant will be issued a receipt upon confirmation of payment at the Registration Desk on the day of meeting.
Request of cancellation will not be entertained.
PRESENTERS only: Attendee substitution may be made from the list of co-authors and must be submitted in writing to
before 15th March 2019.
Checklist BEFORE YOU SUBMIT THIS FORM
Please read all the instructions and check all boxes when completed
Completed all questions
Issued correct amount of fee
Faxed / emailed the bank cheque/draft / transaction slip to the Secretariat
Print this form and bring to the Registration Desk on the day of meeting
If you do not receive any email from the Secretariat for confirmation of registration by 15th March 2019, please contact the Secretariat
Date of form submission (DD/MM/YYYY)
Signature of participant
FOR USE BY SECRETARIAT ONLY
Confirm proof of payment; reference date on cheque/draft/bankslip; Malsec IADR membership info (number, annual registration, dues). Initial & date.Please send an email of acknowledgement of form and particulars.
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