Malaysian Society of Gastroenterology and Hepatology
 
ENDOSCOPY 2004 REGISTRATION FORM
 
 
 
 
       
Name ___________________________________
       
Institution ___________________________________
       
Mailing Address ___________________________________
       
  ___________________________________
     
Tel : _________________ Fax : _________________ Email : _________________
 
 
MSGH Member : YES / NO
   
Deadline for early registration : 30 January 2004
   
Registration Fees
Category
Before 30/1/2004
After 30/1/2004
Doctor (MSGH Member)
RM 200
RM 250
Doctor (non-MSGH Member)
RM 250
RM 300
Nurse and GIA
RM 150
RM 200
GIA Course Only
RM 100
RM 120
 
Payment to be issued to : Malaysian Society of Gastroenterology & Hepatology
   
Enclosed my payment
   
Bank ____________________
   
Cheque No ____________________
   
   
____________________
____________________
Date
Signature
   
   
Enquiries
  
   
Ms Molly Kong Tel : 603 2093 0100, 2093 0200
Academy of Medicine of Malaysia Fax : 603 2093 0900
19, Jalan Folly Barat, 50480 Kuala Lumpur email : acadmed@po.jaring.my