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Message from the Organising Chairperson
The Committee
About PEKA-HUS
Programme
Main Conference
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Registration
Registration Fee
Online Registration
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Conference Venue
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Online Registration
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Registration
Online Registration
(
) Required information
Participant Particulars
Title
-Select-
Dr
Prof
Assoc. Prof
Dato'/Datuk
Datin
Mr
Mrs
Ms
Full Name
Mobile No.
Including country and area codes
Email
MMC No.
Please include N/A if not available
Identification / Passport No.
Do not include hypen for IC No.
Date of Birth
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Degree / Postgraduate Degree
Specialty
-Please select-
Public Health
Midwifery
Neonatology
Obstetrics
Paediatrics
Others
Department
Institution / Organisation
Address
Postcode/Zip Code
State
— Select State —
Johor
Kedah
Kelantan
Melaka
Negeri Sembilan
Pahang
Perak
Perlis
Pulau Pinang
Sabah
Sarawak
Selangor
Terengganu
W.Persekutuan (KL)
W.Persekutuan (LABUAN)
W.Persekutuan (PUTRAJAYA)
Others
Country
Select Country
Malaysia
Australia
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Japan
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Anguilla
Antarctica
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Armenia
Aruba
Austria
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Bolivia
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Bosnia and Herzegovina
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Bouvet Island
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Chile
China
Christmas Island
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Cook Islands
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Croatia
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Denmark
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Dominican Republic
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El Salvador
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Eritrea
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Eswatini
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
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Guam
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Guinea
Guinea-Bissau
Guyana
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Heard Island and McDonald Islands
Honduras
Hungary
Iceland
India
Iran
Iraq
Ireland
Isle of Man
Israel
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Laos
Latvia
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Libya
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Lithuania
Luxembourg
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Macedonia
Madagascar
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Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
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Moldava
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Timor-Leste (East Timor)
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
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United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, US
Wallis and Futuna
West Bank and Gaza
Western Sahara
Yemen
Zambia
Zimbabwe
Office Telephone No.
(including country and area codes)
Fax No.
(including country and area codes)
Meal Preference
Please state your food preference
Please state your food preference
Vegetarian
Non-Vegetarian
Please select
Letter for Visa Application
Yes
No
REGISTRATION CATEGORY
Please select the respective category.
Private doctor/ Private institution -
RM 550
Public doctor/ Public institution -
RM 500
Member of Medico-Legal Society of Malaysia -
RM 500
Member of Malaysian Society of Anaesthesiologists/College of Anaesthesiologists -
RM 500
House officer -
RM 350
Public/Private Allied Health Professional -
RM 350
Complimentary
Complimentary (Speaker) -
RM 0
Complimentary (OC) -
RM 0
Complimentary (Exhibitor) -
RM 0
Please select a category
Total
PAYMENT METHOD
Bank Transfer
All payments are to be issued in favour of "
Neudimenxion
"
Name of Account:
NEUDIMENXION
Account No.:
800 528 6358
Name of Bank:
CIMB Bank Berhad
- Jalan Rubber Branch
Address of Bank: 282, Jalan Rubber, 93400 Kuching, Sarawak
Tel: +6082-23 8072 ; Fax: +6082-23 8069
Swift Code: CIBBMYKLXXX
Email:
[email protected]
Letter of Guarantee (Student)
Local Purchase Order (LPO)
Proceed with online payment via iPay88
Importance Notice:
iPay88 payment gateway does not accept Corporate / Business / AMEX / Commercial MASTER / VISA Credit Card type. Only personal credit cards are accepted for all online payments.
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