7TH SCIENTIFIC CONFERENCE JKNT 2018 Dr. Mr. Ms. Others Specify ___________________
Full Name
Name on Badge (Space provided is to include title such Dr. Dato’, etc)
Organisation/ Department
Mailing Address
Tel:____________ Fax:___________ E-mail: ___________________
Please tick √ whichever appropriate: I will attend as
Delegate Oral Presentation Poster
Presentation
REGISTRATION FEES
Pre Workshop Conference: RM 100.00 Payment made by Local Order Cash
Main Conference: RM 350.00 Payment made by Local Order Cash
(Please tick √ where applicable)
All payment is to be made to :
PGMES HSNZ (Post Graduate Medical Education Society)
No. Akaun : 563019023310 (Maybank)
Payment slip (copy) of online banking/ cash deposit is to be submitted together with the registration form
Date: Signature:
Send complete form with payment by REGISTRATION POST to:
SECRETARIAT
7TH Terengganu Scientific Conference
Bahagian Perubatan,
Jabatan Kesihatan Negeri Terengganu,
Tingkat 5, Wisma Persekutuan, Jalan Sultan Ismail,
20920 Kuala Terengganu
Tel:09-6222866/ 09-6248333
Fax: 09-6245829
E-mail: [email protected]
REGISTRATION FORM
Name :………………………………………………………..
Address:………………………………………………………...
Tel No: Fax No: E-mail:
I wish to participate in Free Paper Presentation :
Oral Presentation
Poster Presentation
· Please use the enclosed standard abstract form only
· Photocopies of the forms may be reproduced for use
· Send 2 copies of abstract to the Secretariat of 7th Terengganu Scientific Conference
The abstract shall be sent by 30th May 2018 to:
SECRETARIAT
7th Terengganu Scientific Conference
Bahagian Perubatan,
Jabatan Kesihatan Negeri Terrengganu,
Tingkat 5, Wisma Persekutuan, Jalan Sultan Ismail,
20920 Kuala Terengganu
Tel:09-6222866/ 09-6248333
Fax: 09-6245829
Email: [email protected]
Abstract can also be submitted by e-mail to :
Dr. Hasnan bin Arwit@Hassan (Oral) E-mail: [email protected]
Dr. Mahani Nordin@Kamaruddin (Poster) E-mail: [email protected]
ABSTRACT SUBMISSION FORM