JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Event registration
Neurosurgical Association of Malaysia (NAM) Annual General and Scientific Meeting 2016
Date: 26th & 27th August 2016
Time: 8.00am to 5.00pm (both days)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Title
Prof
Dr
Dato'
Datin
Mr.
Mrs.
Ms.
Name
Your answer
Hospital/ Institution
*
Your answer
Speciality
*
Your answer
Correspondence Address
*
Your answer
Telephone number
*
Your answer
Category
*
Choose
Consultant/ Specialist
Private sector Specialist
Overseas participant
Registrar
Medical officer
House officer
Medical student
Paramedics
Nurse/ Medical assistant
Registration fees
*
Consultant/ Specialist - RM 550
Registrar - RM 450
Medical officer/ House officer - RM 400
Paramedics/ Nurses/ Medical assistants - RM 350
Medical students - RM 250
Overseas Participant (Surgeon ) - 150 USD
Overseas Participant (Doctor ) - 100 USD
Required
Suturing and Drilling Workshop - 25th August 2016
Will you be joining us? - RM 200
Choose
Yes
No
Payment option
*
Cash - upon arrival (additional RM 50 from original price)
Cheque - to be sent before 20th august 2016
Bank transfer - to Maybank Account Paneuros: 510198680543 (kindly email us electronic copy of receipt)
LPO
Sponsors
Required
Attendance to Gala Dinner (Theme: Friday Night Spooks! - halloween )
Choose
Yes
No
Dietary restrictions
*
None
Vegetarian
Other:
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
