Download registration form (.pdf) - Persatuan Genetik Malaysia

REGISTRATION FORM
Please complete and send this form by fax (Fax: +603 2161 6560) or email (mgc2013@console.com.my)
PLEASE TYPE or WRITE CLEARLY IN BLOCK LETTERS.
A) Delegate Details
Title: Prof Dr Mr Mrs Ms
3 rd – 5 th December 2013 | Hotel Sunway Putra, Kuala Lumpur
Surname:
First Name:
Job Title:
Organisation:
Address:
Postcode:
Country:
Tel: Mobile: Fax:
Email:
B) Registration Fees
Delegate Description
Fees
Delegate PGM Member
Delegate Non-Member
Student Under-grad/ Post-grad/ Post-doc
International Delegate
RM 600
RM 700
RM 500
RM 900 (USD300)
a. Please attach a letter with organisation letterhead and Head of Department / Faculty’s signature that confirms your status as Student
Under-grad/ Post-grad/ Post-doc.
b. The Congress registration fees for the delegate include admission to all sessions and the cost of all Congress coffee breaks and lunches but
not the optional Congress Dinner, optional tours, airport transfer and accommodation.
c. Acceptance of Registration is at the sole discretion of the Organising Committee. Confirmation of Registration will be sent in writing upon receipt
of full payment.
d. The RM/USD conversion rate is FIXED at RM3.10=USD1.00 for the Congress and is not subject to any current rate that may differ.
e. Please attach a undertaking letter with organisation letterhead and head of department’s signature if the payment will be made AFTER the
Congress.

3 rd – 5 th December 2013 | Hotel Sunway Putra, Kuala Lumpur
REGISTRATION FORM
F) Payment Details
Enclosed is my total payment of RM
1. Company Cheque (for Malaysian only)
Cheque No:
Cheque Issuing Bank:
*Important Note: Kindly make cheque/bank draft payable to the MGC 10
to be made through: (tick appropriate box)
2. Local Order (LO Reference No: )
3. Telegraphic Transfer
T.T Reference No:
T.T From (Bank Name):
*Important Note: Please scan your TT slip and email to the Professional Congress Organiser for verification.
4. Credit Card
Type of Credit Card:
Visa Master AMEX
I authorise Console Communications Sdn Bhd to debit the total amount of RM
from my credit card (details provided below) for the registration fees.
Name of Card Holder:
Expire Date (MM/YY)
*CBC /CVC Code
* Visa / Master: The last 3 digit number on the reverse side of your card.
AMEX: The 4 digit number on the left / right of your card.
Credit Card Number:
Card Issued by (Bank):
Card Holder's Signature:
Date:
F) Terms and Conditions:
• All payments must be made in RM. International delegates can make payment by Credit Card, or Telegraphic Transfer. Malaysian delegates
can make payment by Local Cheque, Local Order, Credit Card or Telegraphic Transfer.
• Please note that all related bank charges, financial charges or credit card commission (5%) are to be borne by the delegates and are not to
be deducted from the fees payable to the Congress.
• Company Cheque (for Malaysian only), Local Order (for Malaysian only), and Telegraphic Transfer is to be made to the following Congress
bank account:
Account Name: MGC 10
Account No: 562834623609
Bank Name: Maybank Islamic
Bank Address: No 7 & 9, Jalan 9/9C, Seksyen 9, Bandar Baru Bangi, 43650 Bangi, Selangor
SWIFT code: MBBEMYKL
Confirmation
• Registration will only be confirmed upon receipt of FULL PAYMENT.
• Upon receipt of the FULL payment, the Congress Secretariat will send you a Confirmation Letter via email.
• Please bring along the Confirmation Letter and present it upon registration at the Congress.
Cancellation Policy
• Cancellation of registration must be made in writing to the Congress Secretariat. Refunds will only be made after the Congress.
• Cancellation received on or before 3 rd September 2013 : 100% refund (minus an administration fee of RM90)
• Cancellation received between 3 rd September 2013 to 31 st October 2013 : 50% refund
• Cancellation received after 31 st October 2013 : No refund
*Paid registration fee is not refundable after the stipulated date for whatever reasons, including failure of obtaining VISA.
Please forward the completed Registration Form to:
Professional Congress Organiser
Console Communications Sdn Bhd
Suite 12.9, Level 12,Wisma UOA ll
21, Jalan Pinang 50450 Kuala Lumpur
Tel: +603 2162 0566 Fax: +603 2161 6560
Email: mgc2013@console.com.my Website: www.persatuangenetikmalaysia.com