Evidence-Based Diabetes Care Workshop: FIT-MY Injection Technique Guideline and Medical Nutrition Therapy (KUCHING, SARAWAK) YEAR 2020
Date: 1.3.2020 (Sunday)
Time: 8am-5pm
Venue: Akademi Binaan Malaysia Wilayah Sarawak
Email address *
A. DELEGATE DETAILS
Title: *
Name (in FULL and BLOCK LETTERS) *
Your answer
Occupation: *
Organisation *
Your answer
Department *
Your answer
Address *
Your answer
Postcode *
Your answer
State *
Your answer
Country *
Telephone Number (office): Please include your extension number - Eg. 082xxxxxx Ext xxx
Your answer
Mobile Phone Number *
Your answer
Fax
Your answer
Are you a vegetarian? *
B. REGISTRATION FEES
The registration fee includes admission to all sessions , coffee breaks and lunch ONLY.

Acceptance of registration is at sole discretion of the Organising Committee.

Confirmation of registration will be provided in writing only after receipt of full payment.
MDES Member *
Please enter your membership number if you are MDES member.
Your answer
Category (Early Bird Registration On or Before 1.2.2020) *
C. Payment
ALL payment made payable to MALAYSIAN DIABETES EDUCATORS SOCIETY

Please email proof of payment to fitmykch2020@gmail.com
Payment Method: *
Please indicate Cheque/Telegraphic Transfer/Online Transfer Transaction Number & Issuing Bank (Eg. 123456789012123 Maybank) *
Your answer
D.TERMS AND CONDITIONS
All payments must be made in Ringgit Malaysia

Payment by Cheque, Telegraphic Transfer and Online Transfer is to be made to the following bank account

Account Name : MALAYSIAN DIABETES EDUCATORS SOCIETY
Name of bank : CIMB Bank Berhad
Account No. : 8008256175
Address : CIMB Midvalley Kuala Lumpur
SWIFT code : CIBBMYKL

Please note that all related bank charges and financial charges are to be borne by the delegates and are not to be deducted from the fees payable to the workshop.

E.CONFIRMATION
Registration will only be confirmed upon receipt of FULL PAYMENT.

Upon receipt of the FULL PAYMENT, the Secretariat will send you a Confirmation Letter via email.

Please bring along the Confirmation Letter and present it at the time of Registration at the workshop.
F.CANCELLATION POLICY
Cancellation of registration must be made in writing to the Secretariat. Refunds will only be made after the workshop.

Cancellation received on or before 1st February 2020: 50% refund.

Cancellation received after 1st February 2020: No refund.

* Paid registration fee is not refundable after the stipulated date for whatever reasons.

For further info, please contact:

The Secretariat (Attention to Mr. Felix)
Malaysian Diabetes Educators Society (MDES)
H/p no.: +60 11-1616 9276
Email: fitmykch2020@gmail.com
I hereby have acknowledged, read, understood and agreed on the above terms and conditions.
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy