WHAT Medicine 2009 Conference Registration - Group [ page 1 of 3 ]

Please fill in English
* Mandatory Field

Personal Particulars

Name	*
Name to be printed on certificate	*
Position / Job Title	*
Organisation / Institution	*
Address	*


City
State
Postal Code
Country	*
Telephone	(Country code - Area code - Tel no. eg. 60312345678) *
Fax	(Country code - Area code - Fax no. eg. 60312345678)
Email	*

Registration Fees

Registration Fees per Delegate
Category		No. of Delegates
Local Participant	RM 500
International Participant	USD 150
Local Student	RM 200
International Student	USD 80
Sub Total : RM
Discount : RM
Grand Total : RM
For group registration of more than 10 participants, registrant are eligible to 5% discount on total registration cost.

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