MALAYSIAN DENTAL ASSOCIATION SOUTHERN ZONE (MDASZ) AGM 2015 Date: 08/03/2015 (Saturday) Time: 8.30am to 5.30pm Venue: New York Hotel, JB TIME PROGRAMME 8.30-9.00am Registration 9.00-10.30am Lecture Topic 1: TBA 10.30-11.00am Tea break & Trade Exhibition 11.00-12.00am MDASZ AGM 2014 12.00- 2.00pm Lunch & Trade Exhibition 2.00 -3.00 pm Lecture Topic 3: Update on GST 3.00-3.30 pm Tea Break & Trade Exhibition 3.30-4.30pm Lecture Topic 2: Update on GST 4.30-5.00pm Closing Ceremony CDP : A4 (4 points) Pending for approval REGISTRATION FORM AGM MDASZ 2015 Date : 8th March 2015 Venue : New York Hotel, Johor Bahru PARTICIPANT’S DETAILS (Please complete this form in BLOCK letters) Title (Please ): Professor Dato Datin Dr Mr Mrs Ms Name : ____________________________________________________________________________ (As appears on your Identity Card) (In BLOCK Letters) Institution:_______________________________________________________________________ MDC / DCR No.:_____________ Address: __________________________________________________________________________ Postcode: _____________ City: _______________ State: _______________________ Country: _________________ Fax: ______________________ Telephone (Work): _____________________ Telephone (Mobile): _____________________ E-mail: _______________________________________________________ Special Diet: Vegetarian: Others (Please specify):____________________________________ CONFERENCE REGISTRATION FEES Please indicate your registration (Please Participants ): On/ Before 1/3/2015 MDA/SDA Member After 1/3/2015 RM 30 RM 50 PAYMENT, REGISTRATION AND CANCELLATION POLICY Malaysian Dental Association Southern Zone c/o Q&M Dental Surgery Austin , 41-G , Jalan Mutiara Emas 10/19, Taman Mount Austin, 81100 Johor Bahru Tel: +60183558989 Fax: +607 3557878 Email: mdaszregist@yahoo.com a) Cheque / Postal Order / Money Order / Bank Draft b) VISA / MASTERCARD* (delete accordingly) RHB Bank, Taman Sentosa Branch, Johor Bahru Amount RM A/C: 2-01147-0004061-1 Card No Payee: Malaysian Dental Association (SZ) Expiry Date If you bank in directly, please fax the bank-in slip (MM/YY) or email the scanned copy to us together with participant’s name Cardholder Name Signature / Date REGISTRATION POLICY: 1. Your registration will be valid when payment is received in full by the organizer. 2. The organizer reserve the right to amend any part of the programme without giving prior notice should the need arise. 3. The organizer reserve the right to cancel the conference or any part thereof without prior notice in the event of acts of God, fire, acts of government, terrorism, war or any other event beyond the control of the organizer. 4. For onsite registration, only cash payment in Ringgit Malaysia (RM) will be accepted. CANCELLATION POLICY: 1. No cancellation is allowed. No refund will be made after registration 2. No replacement will be accepted.