To: ACCCIM Secretariat Fax: 03-42603080 / Email: acccim@acccim.org.my Registration Form Unleash The Talents Within A Forum For Retired Executive & Professional : Saturday, 1st December 2012 : 8:30am – 1:00pm : The Associated Chinese Chambers of Commerce and Industry of Malaysia (ACCCIM) 6th Floor, Wisma Chinese Chamber 258, Jalan Ampang 50450 Kuala Lumpur Tel : 03-4260 3090 / 3091 Fax : 03-4260 3080 Medium : English Admission Fee : RM80 per person (including an inspiring book) Refreshment will be served at 8.30am Date Time Venue Name: Company name: Address: Tel: Fax: Email: Payment should be made payable to “The Associated Chinese Chambers of Commerce and Industry of Malaysia”. Alternatively, the amount could be banked into ACCCIM account and FAX the bank-in receipt (Attn: Account Department) to ACCCIM for record. Account details:- PUBLIC BANK Berhad A/C: 3149266331 (KLSCCCI)