REGISTRATION FORM

Full Name: CONTACT US

Mr. Mervin Kim Pereira
Email :Info@nace-malaysia.org
IC No.: Phone No: 0123387675

University/Year:
CORROSION
NOTE
1) To confirm the attendance, please
CAMP 2018
Matrix No.: complete the registration form and
deposit to CIMB BANK BERHAD.

Contact No.:
Deadline:15th December 2017
CORROSION
2) Please send your registration form CONTROL BY
and a payment proof (receipt)
Email Address: to:registration@nace-malaysia.org DESIGN
3) Registration fee will not be refunded
on any cancellation.
Emergency Contact:

Relationship:

DATE:
23-25 JANUARY 2018
NACE Member: (Yes/No)
VENUE:
SCHOOL OF MATERIALS & MINERAL
ORGANISEDAND SUPPORTED BY: RESOURCE ENGINEERING CAMPUS,
Member ID: USM 14300 NIBONG TEBAL, PULAU
PINANG, MALAYSIA
 CAMP FEES
TENTATIVE PROGRAMMES RM100 (NACE Member)
RM150 (Non-NACE Member)

PAYMENT OPTION
(A) Enclosed is my Cheque for
RM _____ Cheque No. _____ made
payable to CORROSION
RESOURCE CENTRE SDN BHD

CIMB BANK BERHAD

A/C No: 8007355363

OR

(B) Telegraphic Transfer (TT),

payable to CORROSION
RESOURCE CENTRE SDN BHD

CIMB BANK BERHAD

A/C No: 8007355363
Swift Code: CIBBMYKL

No 31-1 JALAN USJ 9-55, 47620

SUBANG JAYA, SELANGOR,
MALAYSIA.