MALAYSIAN DENTAL ASSOCIATION
SOUTHERN ZONE (MDASZ)
AGM 2015
Date: 08/03/2015 (Saturday)
Time: 8.30am to 5.30pm
Venue: New York Hotel, JB
TIME
PROGRAMME
8.30-9.00am
Registration
9.00-10.30am
Lecture Topic 1: TBA
10.30-11.00am
Tea break & Trade Exhibition
11.00-12.00am
MDASZ AGM 2014
12.00- 2.00pm
Lunch & Trade Exhibition
2.00 -3.00 pm
Lecture Topic 3: Update on GST
3.00-3.30 pm
Tea Break & Trade Exhibition
3.30-4.30pm
Lecture Topic 2: Update on GST
4.30-5.00pm
Closing Ceremony
CDP : A4
(4 points) Pending for
approval
REGISTRATION FORM
AGM MDASZ 2015
Date : 8th March 2015
Venue : New York Hotel, Johor Bahru
PARTICIPANT’S DETAILS (Please complete this form in BLOCK letters)
Title (Please
):
Professor
Dato
Datin
Dr
Mr
Mrs
Ms
Name : ____________________________________________________________________________
(As appears on your Identity Card) (In BLOCK Letters)
Institution:_______________________________________________________________________
MDC / DCR No.:_____________
Address: __________________________________________________________________________
Postcode: _____________ City: _______________ State: _______________________
Country: _________________ Fax: ______________________
Telephone (Work): _____________________
Telephone (Mobile): _____________________
E-mail: _______________________________________________________
Special Diet: Vegetarian:
Others (Please specify):____________________________________
CONFERENCE REGISTRATION FEES
Please indicate your registration (Please
Participants
):
On/ Before 1/3/2015
MDA/SDA Member
After 1/3/2015
RM 30
RM 50
PAYMENT, REGISTRATION AND CANCELLATION POLICY
Malaysian Dental Association Southern Zone
c/o Q&M Dental Surgery Austin ,
41-G , Jalan Mutiara Emas 10/19, Taman Mount Austin, 81100 Johor Bahru
Tel: +60183558989
Fax: +607 3557878
Email: mdaszregist@yahoo.com
a) Cheque / Postal Order / Money Order / Bank Draft b) VISA / MASTERCARD* (delete accordingly)
RHB Bank, Taman Sentosa Branch, Johor Bahru
Amount
RM
A/C: 2-01147-0004061-1
Card No
Payee: Malaysian Dental Association (SZ)
Expiry Date
If you bank in directly, please fax the bank-in slip
(MM/YY)
or email the scanned copy to us together with
participant’s name
Cardholder Name
Signature / Date
REGISTRATION POLICY:
1. Your registration will be valid when payment is received in full by the organizer.
2. The organizer reserve the right to amend any part of the programme without giving prior notice should the need arise.
3. The organizer reserve the right to cancel the conference or any part thereof without prior notice in the event of acts of God, fire, acts of
government, terrorism, war or any other event beyond the control of the organizer.
4. For onsite registration, only cash payment in Ringgit Malaysia (RM) will be accepted.
CANCELLATION POLICY:
1. No cancellation is allowed. No refund will be made after registration
2. No replacement will be accepted.