Transcript Slide 1

The 2nd National Midwives Congress 2014
Theme: “Achieving MDG 5 : It Has And Always Be A Team Effort.
3rd - 5th May 2014 Summit Hotel, Subang Jaya
REGISTRATION FORM
To register, please complete and send/fax registration form together with:
Bank draft / Cross Cheque / Postal Order / LO .
Mail to: The Organizer,
The 2nd National Midwives Congress 2014
National Midwifery Society Malaysia (NMSM)
Nursing Administration Unit, Hospital Tengku Ampuan Rahimah, Klang.
41200, Klang, Selangor
Fax:
03-51617672
Delegate Details
Full name (in block letters) Dr./Prof./Mr/Ms
Gender
: Male
Nationality :
Female
Job Title
Organisation
Address
Post Code
State
Country:
Telephone
Mobile Phone No.:
Fax
Email
Dietary Requirements
(Please tick)
Vegetarian
Non - Vegetarian
Congress Registration Fee
Local Delegates
Early Bird (before 15th April 2014)
Late Bird (After 16 April 2014)
RM700
RM 150
RM 600
RM750
RM 200
RM 650
Package 1
Package 2
Package 3
Mode of payment
Bank Draft
Crossed Cheque / Postal Order / LO ACCEPTED
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Made payable to: PERSATUAN KEBANGSAAN BIDAN MALAYSIA (Association Registration No.: PPM/RSM : 0778)
Public Bank
Account Number: 3169796004
Bank of Issue: ..................................................................................
Reference No.: ...........................................................
Total Amount (RM): ........................................................................
Date: .........................................
Cancellation
Any cancellation of registration must be in writing to the Secretariat.
There will be 80% refund of registration fees for cancellation made before 20th April 2014
No refund of registration fees for cancellations made after 20 th April 2014, however a substitute participant will be allowed.
The Organizer reserves the right to change topics or reschedule the conference in the event of unforeseeable circumstances beyond their control.
If you have any enquiry or doubt, please contact:
Ms. Noraini
0126994334
Ms. Santhi
0122203445
Ms.Zahara
0175975550