Online registration


KL International Neonatology Conference 2019

In Conjunction With World Prematurity Day

Registration Form

Personal Particulars
Title:
Full Name:
Name on Badge: (Limited to 15 alphabets)
Institution Address:
Correspondence Address:
[ Same as above ]
State:
Postcode:
Country:
Telephone:
Fax:
Delegate Email:
Contact Email:
Profession:
(eg: Neonatal trainee, Midwife, etc.)
Specialty:
Remarks:

Registration Fees
Type On/Before
31 Aug 2019
After
31 Aug 2019
Amount
RM950 RM1000
RM1000 RM1050
RM1800
(USD400)
RM2025
(USD450)
RM900 RM950
RM950 RM1000
RM1575
(USD350)
RM1800
(USD400)
RM500
RM1000
RM900 (USD200)
RM1350 (USD300)
Total
* Proof of membership required.
** Priority for the workshop will be given to full KLINC delegates.
# Members of the Federation of Asia-Oceania Perinatal Societies (FAOPS) may be entitled to reduced fees. Proof of membership will be required.
$ Proof of undergraduate status required.

Mode of Payment









Please attach Proof of Payment / Scanned copy of LPO, Bank-in Slip, TT slip:

(only accepts doc/x, xls/x, ppt/x, pdf, jpg/gif/png and zip)

Bank Account name: PERSATUAN PERINATAL MALAYSIA (KLINC)
Bank: CIMB ISLAMIC
Branch: Kampung Baru, Kuala Lumpur
Account number: 8602226030
Swift Code: CIBBMYKL

Offline Payment Remarks:




CONFERENCE SECRETARIAT

Academy of Medicine of Malaysia
Unit 1-6, Level 1
Enterprise 3B, Jalan Innovasi 1, Technology Park Malaysia
Lebuhraya Puchong-Sg Besi, Bukit Jalil, 57000 Kuala Lumpur

(Attention : Ms Kong / Ms Helen Chong)
Tel: +603 89960700, +603 89961700, +603 89962700
Fax: +603 89964700
Email: klincsecretariat@gmail.com