1. finance
2. bank
3. bank account

REGISTRATION FORM
Kindly fill in ALL the details required below. Incomplete form would not be processed. Upon complete
registration and payment, registration confirmation email will be sent to you.
A. DELEGATE’S DETAILS
Title: Datuk / Dato’ / Datu / Datin / Prof / Dr / Mr / Mdm / Ms
Full Name as per IC/ Passport: ___________________________________________________
C/ Passport No: ______________________________________________________________
Correspondence Address:
_____________________________________________________________________________________
_________________________________________________________________
Postcode:
_______________ State / Country: _________________________________
Fax: ________________ Mobile No. : ______________ Email: ____________________
Special Dietary Requirement:
[ ] Vegetarian [ ] Others (Please specify here: _________________________________)
Profession: [ ] Allied Health Professional [ ] Doctor
[ ] Pharmacist
[ ] Dentist
[ ] Health Inspectors
[ ] Others (Please state: __________________________________________)
DEPARTMENT / COUNCIL SPONSOR DETAILS
Department/Unit: ____________________________________________________________
Contact Person’s Name: _______________________________________________________
Mobile Number: _____________________ Office number: __________________________
E-mail: _____________________________________________________________________
*Department / Council Sponsor details are compulsory if you are a sponsor and would like to be updated
on this registration.
B. REGISTRATION FEE
CATEGORY
DELEGATES PACKAGE
(Must register by or before
30th APRIL, 2015)
EARLY BIRD
(Before or On 30th April 2015)
STUDENT PACKAGE
LOCAL
INTERNATIONAL
RM 980
USD 350
RM 880
USD 300
RM 800
USD 250
We accept payment using credit cards, cheque or Local Purchase Order
(Please register early)
*Your registration covers 2 days of conference with meals.
TOTAL AMOUNT DUE: ________________________
C. PAYMENT
All payment are to be issued in favor of KESATUAN INSPEKTOR KESIHATAN, JABATAN KESIHATAN SARAWAK
Bank Name
:
MAYBANK BERHAD
Bank Address
:
LOT 1.03, LEVEL 1, WISMA SATOK, JALAN SATOK, 93400
KUCHING, SARAWAK
Account Number
:
011113003338
Swift Code
:
MBBEMYKL
Accepted payment mode
:
- Online Credit Card Payment
- Bank-In of Cash / Cheque
- Online Transfer / Telegraphic Transfer
- Local Purchase Order (LPO) by Malaysian Government
CONFERENCE SECRETARIAT
HIUS SECRETARIAT
No. 90, 1st Floor, Lot 1167,
Kota Padawan, JalanPenrissen,
93250 Kuching, Sarawak.
Tel: +6082 371799 / +6010 9761897 / +6016 5902135
Email: [email protected] Website: www.hius.org.my
Fax: +6082 241126
An email confirmation will be sent to all confirmed delegates. Please bring it in exchange for your
conference kit during the registration.
CANCELLATION AND REFUND POLICY
The Secretariat must be notified in writing of all cancellations. Refund will be made only after the
conference and only applicable under following circumstances.
Cancellations on or before 30th August 2015 : 50% Refund
Cancellations after 30th August 2015
: No Refund
If no refund is required but a change in participant registration is needed, then the Secretariat must be
informed in writing via e-mail to [email protected]
CERTIFICATE OF ATTENDANCE
A certificate of attendance will be issued to all participant / delegates. CPD points will be awarded.
LIABILITY
The Organizing Committee will not be liable for personal accidents, loss or damage to private property of
the participants during duration of the Conference. Participants should make their own personal
arrangements.
DISCLAIMER
Whilst every attempt is made to ensure that all aspect of the conference as mentioned in this
announcement will take place as scheduled , the Organizing Committee reserves the right to make last
minute changes should the need arise .