11th International Seminar and Workshop "IBADAH FRIENDLY HOSPITAL"

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Date : 18th -20th October 2016
Venue : Auditorium Utama Menara Razak, University Technology of Malaysia

Name / Name *

Kad Pengenalan

Organisation / Institusi *

Position / Jawatan *

Address / Alamat *

Contact No / No Telefon *

Fax / Faks *

E-mail / Emel *

Category / Kategori

PLEASE SELECT YOUR CATEGORY AND INTERESTED PROGRAM/
SILA TANDAKAN KATEGORI DAN PROGRAM YANG ANDA MINATI.

a) Seminar & Workshop

Specialist / Lecturer / Dean - RM 500

Medical Officer / Trainee / Administrator / Religious Officer/ Others - RM 350

Paramedic / Nurse - RM 300

Student - RM 250

Foreign Categories - USD 200

Clear selection

b) Seminar Only

Specialist / Lecturer / Dean - RM 450

Medical Officer / Trainee / Administrator / Religious Officer / Others - RM 300

Paramedic / Nurse - RM 250

Student - RM 200

Foreign Categories - USD 150

Clear selection

c) Workshop Only

Specialist / Lecturer / Dean - RM 150

Medical Officer / Trainee / Administrator / Religious Officer / Others - RM 150

Paramedic / Nurse - RM 150

Student - RM 100

Foreign Categories - USD 100

Clear selection

Payment Method / Cara Pembayaran *

Cash

Online Transfer

Cheque

Credit Card

LPO

Dinner (include fees) : 8.30 p.m, PWTC *

Attend

Not Attend

Additional info/Maklumat tambahan

Transport will be provided for the participants who wants to attend the dinner and we will be depart from UTM at 6:30 p.m. All the participants will be send back to the Grand Season Hotel, Putra Hotel Pusrawi, Scholar Inn UTM, Akar Homestay and University Technology of Malaysia (UTM).
Kenderaan akan disediakan untuk para peserta yang ingin menghadiri makan malam dan akan bertolak dari UTM pada jam 6.30 petang. Para peserta juga akan dihantar pulang ke Hotel yang berkenaan seperti Hotel Grand Season, Hotel Putra Pusrawi, Scholar Inn UTM, Akar Homestay dan Univerisiti Teknologi Malaysia (UTM).

PAYMENT CAN BE MADE TO / PEMBAYARAN BOLEH DIBUAT KEPADA:

Konsortium Hospital Islam Malaysia Sdn. Bhd.
Public bank : 3985205030

Fax / Email Payment Slip to : khim.hospitals@yahoo.com
+603 2692 1007
+603 2692 5546

Untuk Maklumat Lanjut, sila hubungi:

Konsortium Hospital Islam Malaysia
No 85, Jalan Raja Abdullah, Kampung Baru
50300 Kuala Lumpur, Malaysia

Emel : khim.hospitals@yahoo.com
No Tel : +603 2693 1007 samb. 216/217
: +6019 238 1007

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