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: iadrmalsec@gmail.com
Full Name of Participant *
(First middle LAST name)
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Title
Malaysian Section IADR membership number
(ignore if not a member)
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Main IADR member number
(ignore if not a member)
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E-mail address *
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Telephone number (mobile) *
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Organisation *
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Mailing address *
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Do you require VEGETARIAN meal? *
Participation category *
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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
TERMS AND CONDITIONS OF REGISTRATION *
Please read all the terms and check all boxes when done.
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Checklist BEFORE YOU SUBMIT THIS FORM *
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Date of form submission (DD/MM/YYYY) *
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Signature of participant
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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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