REGISTRATION FORM FOR
PRE-CONGRESS SYMPOSIUM

(Required for all intending participants including those who have registered for the Main Congress.)


Name of delegate:

Identity Card number:
(for doctors as in MMC-CME registration)
Current Post:
 
Contact Address:
 
Tel No:
Fax No:


Are you a member of the Perinatal Society of Malaysia?

Yes

 

No

 

Fees to be paid (please circle and write the relevant amount)

Registered for Main Congress
Free
Not Registered for Main Congress
RM50

Please make payment by cheque, bank draft, or money order payable to 'Perinatal Society Congress' and send to the Congress Secretariat.

Acknowledgment of registration, receipt of payment and a final programme will be posted to you nearer the date of the event.