MAPO CONTINUING PROFESSIONAL DEVELOPMENT 2019 REGISTRATION FORM
Theme : FROM EYECARE TO EYEWEAR

*Venue : Verdant Hill Hotel Kuala Lumpur, Level 7

Google Map: https://goo.gl/maps/tyLvfTBwJSdmm2hC8

Waze: https://waze.com/ul/hw283fmk36

*Date: 22nd & 23rd August 2019

*The registration will be closed by 9 August 2019 (Friday)5pm or after the last seat is taken.

*Registration Fee:
-MAPO Active Ordinary Members / Life Members : RM100
-MAPO Active Student Members / Associate Members : RM150
-Non Members :RM300

*Methods of Payment:

A. By cash or cheque to MAPO secretariat at MAPO office or any MAPO official events (e.g. AGM, MAPO CPD , etc). All cheques should be crossed and made payable to "The Malaysian Association of Practising Opticians". Please write your name, contact number , and/or MAPO membership number (e.g. OM100) on the reverse side of you cheque. Cheque can also be mailed to MAPO office at the address of: Suite 12B-10, Tingkat 12B, Wisma Zelan, 1, Jalan Tasik Permaisuri 2, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.

B. By internet banking or bank deposit to MAPO Maybank account 564762200259 under name of "The Malaysian Association of Practising Opticians". Please send the payment receipt by writing down your name, contact number , and/or MAPO membership number (e.g. OM100) to secretariat@mapo.org.my or Whatsapp to https:/wa.me/60163320348

* It is COMPULSORY to submit the form and email the FULL payment details to MAPO office.

*If you did NOT receive any notification within a week, you can follow up with a call to MAPO office at +603-91731770

* After received the confirmation of you registration, you are required to register at MyCPD2 (https://www.mycpd2.moh.gov.my/) BEFORE the event date to be able to record your CPD points.

FULL NAME AS PER NRIC *
Your answer
GENDER *
Required
MOBILE NUMBER *
Your answer
EMAIL ADDRESS *
Your answer
NAME OF PRACTICE *
Your answer
DESIGNATION *
Eg: Optician
Your answer
ADDRESS OF PRACTICE *
Your answer
MOC REGISTRATION NO *
Eg. J01000. Please write "NONE" if you are not registered under MOC
Your answer
MAPO Membership NO *
Eg. OM0010. Please write "NONE" if you are not MAPO member
Your answer
ACCOMMODATION NEEDED *
Only for outstation participants (45KM from the your practice to the venue using shortest route from Google Map). Only application to MAPO Active Ordinary members / Life members. Participants invited by sponsors are NOT entitle for the free accommodation. Limited Twin Sharing rooms provided. First come First serve.
Required
INVITED BY SPONSOR *
Participants invited by sponsors are required to issue a cheque of RM150 payable to "The Malaysian Association of Practising Opticians". MAPO will return the cheque upon full participation of TWO days' seminar.
SPONSOR'S COMPANY NAME *
Your answer
Event Day 1
Event Day 2
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