CARDIOVASCULAR, NEUROVASCULAR & STROKE
WORKSHOP 2015
27th - 28th March 2015 | Aloft Kuala Lumpur Sentral
ONLINE REGISTRATION
Please complete the following registration form. Make sure to include ALL contact information (email address, mailing address, telephone & fax number) to ensure receipt of your Registration Confirmation email. All registration MUST be accompanied with payment. Registration without payments will not be processed.
A. PERSONAL DETAILS
Title  
Name On Badge   * Limited to 15 letters only
Full Name as per IC / Passport  
IC Number  
Institution / Hospital  
Correspondence Address  
City  
Postcode  
Country  
Letter for Visa Application  
Yes No
Mobile Number   (country code)(area code)(telephone no)
Fax   (country code)(area code)(fax no)
Email  
Profession  
Radiologist Interventionist Neurologist
Cardiologist Radiographer Assistant Interventionist
Others
Dietary Requirement  
Vegetarian Non-Vegetarian
     
B. INSTITUTION / COMPANY SPONSOR DETAILS
* If you are registering for yourself, please go to part C
Contact Person's Name  
Institution / Company Name  
Mobile Number  
Office Number  
Email  
    * Institution / Company Sponsor details are compulsary if you are a sponsor
   and would like to be kept updated on registration.
     
C. REGISTRATION FEES
     
Please select the relevant option
Categories Early Bird (by 14th Feb 2015) Post Early Bird (by 15th Feb 2015 to Onsite)
Malaysian & ASEAN Participant
 RM 1,500
 RM 1,800
Other Countries Participant
 RM 1,800
 RM 2,100
     
TOTAL AMOUNT DUE   RM 
     
D. PAYMENT MODE
Please Select Payment Mode  
Bank-in Cash or Cheque PayPal
Online Transfer or Telegraphic Transfer    
     
Attach Proof    [ max file size : 20MB ]
    Please attach scanned document of either bank-in cash, bank-in cheque or online transfer slip or telegraphic transfer slip.
    *Please make sure the name of the attachment does not contain special characters.
 
All payments are to be issued in favour of "MD CME ASIA SDN BHD"
Bank   Malayan Banking Berhad (MayBank)
Account No   514253521372
Swift Code   MBBEMYKL
Bank Address   1 Jalan Maarof, Dataran Maybank, 59000 Kuala Lumpur
Bank Branch Telephone   +603 2283 1017
 
All registered conference participants will be emailed confirmations after payment has cleared. If you have not received your registration confirmation email within one week, please contact the secretariat at +603 2242 0902 or email to secretariat@mdcmeasia.com
 
Conference Secretariat
CVNS 2015
c/o
Bloom Communications
P1-2-1, Andalucia, Pantail HillPark,
Jalan Pantai Permai, 59200 Kuala Lumpur Malaysia.
Tel: + 603 2242 0902 / + 6016 206 9610
Fax: + 603 6207 6795
     
Cancellation & Refund Policy
The secretariat must be notified in writing of all cancellations.
 
Cancellation before or on 28th February 2015 : Amount paid minus bank charges.
Cancellation on or after 1st March 2015 : No refund
     
If no refund is required but a change in participant registration is needed, then the Secretariat must be informed in writing via email to secretariat@mdcmeasia.com
 
Certificate of Attendance
A certificate of attendance will be issued to all delegates.
 
Liability
The Secretariat will not be liable for personal accidents, loss or damage to private property of the participants during duration of the Conference. Participants should make their own personal arrangements.
 
Disclaimer
Whilst every attempt is made to ensure that all aspect of the conference as mentioned in this announcement will take place as scheduled, the organisers reserves the right to make last minute changes should the need arise.
     
 
 
 
CONTACT US  
CVNS 2015 c/o Bloom Communications P1-2-1, Andalucia, Pantai Hillpark, Jalan Pantai Permai, 59200 Kuala Lumpur, Malaysia.
   
Contact Details Ms San San
Contact Number +603 2242 0902
Fax Number +603 6207 6795
Email Address secretariat@mdcmeasia.com
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