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Registration Form
ONLINE REGISTRATION
Individual Registration (Own Payment)
For Those Sponsored By Company (Individual And Group Registration or LPO), Please Click
HERE
Registration Type
:
Overseas
Local
A. PERSONAL DETAILS
Title
:
Select Title
Prof
Dr
Datuk
Dato'
Datin
Mr
Mdm
Ms
Name On Badge
:
* Limited to 15 letters only
Full Name as per IC / Passport
:
* Please ensure full name & correct spelling as the name will be printed on your certificate
Profession
:
Orthopaedic Surgeon
Others
Institution / Hospital
:
Correspondence Address
:
Postcode
:
Country
:
Select Country
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua & Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia & Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina
Myanmar
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Côte dIvoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican
Republic
Ecuador
East Timor
Egypt
El Salvador
England
Equatorial Guinea
Eritrea Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Great Britain
Greece
Grenada
Guatemala
Guinea
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Ireland
Oman
Pakistan
Palau
Palestinian State
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
St. Kitts & Nevis
St. Lucia
St. Vincent & The Grenadines
Samoa
Saudi Arabia
Scotland
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Wales
Yemen
Zaire
Zambia
Zimbabwe
Letter for Visa Application?
:
Yes
No
Mobile Tel Number
:
(country code)(area code)(telephone no)
Fax
:
(country code)(area code)(fax no)
Email
:
Dietary Requirement
:
Vegetarian
Non-Vegetarian
B. REGISTRATION FEES
Please tick the relevant check boxes.
Category
Meeting Package
Post Early Bird
(1st Aug - 30 Sept 2014)
Onsite
(1st Oct 2014 - Onsite)
MAS Member
(Local)
Lectures Only
RM 1,250
RM 1,550
Lectures + Hotel (2 Nights)
RM 2,050
RM 2,350
Non MAS Member
(Local + Overseas)
Lectures Only
RM 1,650
RM 1,950
Lectures + Hotel (2 Nights)
RM 2,450
RM 2,750
If you are a MAS Member, Please select your membership category
Select One
Life Member
Ordinary Member
Assoc Member
MAS membership No
:
If your membership detail is not filled in or is no longer current, your registration will automatically be processed as non-MAS member. If you wish to update your membership immediately or check your status, please contact MAS secretariat at +603 2242 0902 / secretariat@my-arthroscopy.com
Total Amount Due
:
RM
Room allocation and bed type is subject to availability at point of check-in and is based on first-come-first-served basis during check-in.
Check-in is from 3.00pm on 31 Oct 2014 and check-out is before 12.00noon 2 Nov 214
Any early arrival or late departure shall be subject to charges.
Each room is for a maximum of 2 persons per room and includes breakfast for 2 and high speed internet access.
No refunds will be given should there be a non-arrival/no show.
Extra beds are chargeable at Rm 130.00++ per bed and include a buffet breakfast for either adult or child.
The rates applicable are for a minimum of 2 nights stay at the hotel.
C. PAYMENT
Payment Method
All payments are to be issued in favour of
“MALAYSIAN ARTHROSCOPY SOCIETY”
Bank
:
CIMB Bank
Account Number
:
8000913139
Swift Code
:
CIBBMYKL
Bank Address
:
Lucky Garden, Bangsar, Kuala Lumpur
Please Select Payment Mode
:
Bank-in Cash or Cheque
Online Transfer or Telegraphic Transfer
Attach Proof
:
[ max file size : 20MB ]
* Please make sure name of the attachment does not contain special characters.
* Please attach scanned document of either bank-in cash / cheque proof or online / telegraphic transfer proof.
CANCELLATION AND REFUND POLICY
The secretariat must be notified in writing of all cancellations. Refund will be made only after the conference and only applicable under following circumstances.
Cancellation on or before 30th September 2014 : 50% refund
Cancellation after 30th September 2014 : no refund
If no refund is required but a change in participant registration is needed, then secretariat must be informed in writing via email to secretariat@my-arthroscopy.com
All registered conference participants will be emailed confirmations. If you have not received your Registration Confirmation Email within two weeks of registration, please contact the Secretariat at +601 6203 6018 / +603 2242 0902 or email to
secretariat@my-arthroscopy.com
Mailing Address
Secretariat
MALAYSIAN ARTHROSCOPY SOCIETY (MAS)
P1-2-1, Andalucia, Pantai Hillpark
Jalan Pantai Permai, Bangsar South
59200 Kuala Lumpur, Malaysia
Bloom Communications
Tel: +603 2242 0902 / +6016 203 6018
Fax: +603 6207 6795
Email: secretariat@my-arthroscopy.com
Website:
www.my-arthroscopy.com
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