Come join us for an unforgettable experience! - Malaysian Dental ...

PAYMENT
Please make bank draft/ cheque in Ringgit Malaysia (RM) made payable to: 35th APDC/MDA
a) Bank Draft/Cheque Number: for the amount RM:
• Registration will not be accepted without payment
b) Credit Card No. Please deduct RM
Card Expiry Date
Name as appears on Card
Signature
Date
Cancellation Policy:
1) All requests for cancellation are to be made in writing to the MDA Secretariat. Fees will be refunded according to the
following schedule:
Cancellation of registration Penalty Refunded amount
On or before 15/4/2013 50% of registration 50 % of registration
After 15/4/2013 100% NIL
2) Refund will only be made one month after the convention.
3) No replacement is allowed.
The Disclaimer to Registration Policy:
A) Please note that a separate registration form must be used for each participant.
B) Registration will be valid when payment is received in full.
C) The organizing committee reserves the right to change or cancel the programme without prior notice if circumstances dictate.
D) On line registration registration will close on 1/5/2013.
E) For online registration, ONLY credit card in Ringgit Malaysia will be accepted.
F) Delegates who wish to attend Hands-on Workshops must prior be fully registered for the main convention.
Please mail registration form with payment to:
Kindly refer to MDA website: www.mda.org.my for updates
www.35thAPDC2013.com
Malaysian Dental Association
No. 54-2, Medan Setia 2, Plaza Damansara, Bukit Damansara,
50490 Kuala Lumpur, Malaysia.
Tel: +603-2095 1495 Fax: +603-2094 4670
Email: mda@streamyx.com / mdentalassoc@gmail.com