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: fadilah_h@moh.gov.my

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: ymaliza@moh.gov.my

Abstract can also be submitted by e-mail to :

Dr. Hasnan bin Arwit@Hassan (Oral) E-mail: drhasnan@moh.gov.my

Dr. Mahani Nordin@Kamaruddin (Poster) E-mail: drmahani07@moh.gov.my

ABSTRACT SUBMISSION FORM