REGISTRATION FORM
6
thREGIONAL CONFERENCE ON MOLECULAR MEDICINE (RCMM) 2015 IN CONJUNCTION WITH 2
ndNATIONAL CONFERENCE FOR CANCER RESEARCH
23-25 October 2015, Hotel Sunway Putra, Kuala Lumpur
PERSONAL INFORMATION FULL NAME :
DESIGNATION :
ORGANISATION : POSTAL ADDRESS :
PHONE (OFFICE) : PHONE (MOBILE):
FAX : EMAIL :
REGISTRATION FEE
The fee will cover the cost of conference materials, lunch, tea breaks & certificate.
PARTCIPANTS FEE (RM) PLEASE TICK ()
Internationals Participants 1,000.00
Researchers / Scientists 800.00
Students 700.00
Total Payment (rates are inclusive of 6% GST).
SUBMITTING AN ABSTRACT? YES NO VEGETARIAN YES NO
PAYMENT DECLARATION
Please tick ().
MODE OF PAYMENT. REMARKS
(If any)
I hereby enclosed a bank draft/cheque (No: ) of RM: ...
made payable to “Bendahari Universiti Kebangsaan Malaysia”.
(1) Kindly mail your bank draft/cheque to the secretariat.
Local bank transfer
(1) Kindly email us [email protected] the receipt upon payment has been made.
Local order (No. )
(1) Please mail your original Local Order or bring on the registration day.
(2) Please email the Electronic Fund Transfer (EFT) to
[email protected] the receipt upon payment has been made.
Payment by sponsor
(1) Please email the letter of approval / sponsorship by your organisation or company to [email protected].
SIGNATURE : DATE :
BANK INFORMATION
ACCOUNT : Bendahari Universiti Kebangsaan Malaysia ACCOUNT NO. : 86-0008114-0
BANK : CIMB Berhad
BANK ADDRESS : CIMB Cawangan Taman Maluri, No. 279 & 279A, Jalan Perkasa 1, Taman Maluri Off Jalan Cheras, 55100 WP Kuala Kumpur, Malaysia CPB/GST UKM : 0017 8225 9712
SWIFT CODE : CIBB MYKL
ACCOMMODATION
The fees will not cover accommodation. Kindly please contact the Sunway Putra Hotel for reservation.
Sunway Putra Hotel Kuala Lumpur
100 Jalan Putra, 50350 Kuala Lumpur , Malaysia
Tel: +603 4040 9888 Fax: +603 4043 0700 Email : [email protected] Room Reservations : [email protected]
REFUND POLICY
No refund will be made for no-shows. To cancel the registration with refund, secretariat must receive your cancellation request in written form or by email no later than 2 weeks before course/seminar date.
SUBMISSION
Please send completed form and payment to:
Secretariat of 2nd National Conference for Cancer Research in conjunction with 6t h Regional Conference on Molecular Medicine (RCMM) 2015
UKM Medical Molecular Biology Institute (UMBI) Jalan Yaacob Latiff, Bandar Tun Razak
56000 Cheras, Kuala Lumpur Malaysia
Contact person: Norshamsiah Hamim (+603 – 9145 9037) / Norsuzana Abd Rahman (+603 – 9145 9023) Fax : +603 – 9171 7185 Email : [email protected]
