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CONNECTING THE DOTS FOR CHILDREN WITH SPEECH & LANGUAGE DELAY
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* Required
NAME
*
Your answer
NRIC / Registration Number
*
Your answer
Institution / Work Place
*
Your answer
Profession / Job
*
Please Select You Job
Doctor
Teacher / Lecturer
Audiologist
Speech Language Pathologist
Paramedic
Self-employed
Other:
What is your EMAIL address?
*
Your answer
Contact Number ( handphone)
*
Your answer
Home Address
Your answer
State
*
Choose
Pahang
Terengganu
Selangor
Johor
Kelantan
Perlis
Kedah
Pulau Pinang
Perak
Melaka
Negeri Sembilan
Sabah
Sarawak
Dietary Requirement
*
NO, I am not a Vegetarian
YES, I am a Vegetarian
REGISTRATION FEE
*
Choose
RM220.00 PUBLIC
RM150.00 IIUM STAFF
RM 100.00 STUDENT
Complimentary - Committee Members / Speaker
PAYMENT
TENTATIVE
Further Information ?
FOR ENQUIRES
Email:
iiumdots2018@gmail.com
Facebook:
https://www.facebook.com/KOMaudiologyunit
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