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((MALAYSIAN

Dental Therapists'
ASSOCIATION

Malaysian Dental Therapists'


Scientific Conference

28 30 April 2017
Berjaya Times Square, Kuala Lumpur

Organized by
Malaysian Dental Therapists' Association
PARTICIPANT REGISTRATION FORM

3rd MALAYSIAN
DENTAL THERAPISTS SCIENTIFIC CONFERENCE 2017
New Direction For Better Future
Venue: Berjaya Times Square, Kuala Lumpur

Name: .(Block letters)

Mailing address:

..

Tel No:. Fax No : .. Mobile No: . Email :

Special Diet: Vegetarian Others Please specify

CONFERENCE REGISTRATION FEES


Please indicate yours registration
Participants Registration Fees before 1 April 2017 On-Site Registration
PJPM member RM 400.00 RM 450.00
Non PJPM member RM 450.00 RM 500.00
Student RM 270.00 RM 270.00
Foreign Participant USD200.00 USD250.00
Gala Dinner RM 150.00

Please reply registration to secretariat by email or fax


PAYMENT:
Please make bank draft/ money order/ cheque / Local Purchase Order (LPO) in Ringgit Malaysia (RM) made
payable to:
Persatuan Jururawat Pergigian Malaysia. A/C No: 86-0031237-5 (CIMB Bank)
a) Bank draft /money order/ cheque number :for the amount

RM ..(Registration will not be accepted without payment)

Address: 3rd Malaysian Dental Therapist Scientific Conference Secretariat


Oral Health Division
Ministry of Health Malaysia
Level 5, Block E10, Parcel E, Precint 1
Federal Government Administrative Centre
62590 Putrajaya

Signature:...
Date:
Disclaimer: The Organizing Committee reserves the right to change or cancel the programme Without
any prior notice if circumstances dictate;

Contact Person:
Mrs Fatimah Rahman (012-9113846) email : fatimahrahman@gmail.com
Mrs Arbiah Basri (019-9393542) email : arbiah.basri@moh.gov.my
Mrs Norliza Jamalludin (019-3294429) email : n_liza @moh.gov.my
Fax number : 03-88886133

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