Delegate Details
Title: * Prof     Dr     Mr     Mrs     Ms    
Full Name: *
Name on Badge: *
Affiliated Organisation / Institution: *
Address: *
 
State: *
Country: *
Postal Code: *
Phone: *
Mobile:
Fax: *
E-mail: *
Are you vegetarian? *  Yes   No
 

Registration Fees
The Registration Fees do not include the Postgraduate Course.  Please register below for the Postgraduate Course
Type of Registration Early registration
(before
1st May 2010)		 Registration
( 1st May 2010 to
9th September 2010)		 Onsite
(10th September to
time of meeting)
Doctors
USD 400
USD 450
USD 600
* Allied Health Personnel
USD 200
USD 250
USD 300
* A letter of verification of the Allied Health Personnel status from the Head of Department/ Unit must be enclosed.

 

Postgraduate Course (19th September 2010)
Not joining Early registration
(before
1st May 2010)		 Registration
( 1st May 2010 to
9th September 2010)		 Onsite
(10th September to
time of meeting)
USD 100
USD 150
USD 200
 

Payment
My total payment of USD to be made through:
Master or Visa card:
I have authorised the Asian Pacific Digestive Week 2010 to debit the total amount of USD
  from my credit card for the settlement of the above mentioned fees.
Name of Card Holder:
Card Number: - - -
Expiry Date: -
Card Issuing Bank:
CBC Code (The last three digits on the reverse side of your card)
AMEX card:
I have authorised the Asian Pacific Digestive Week 2010 to debit the total amount of USD
  from my credit card for the settlement of the above mentioned fees.
Name of Card Holder:
Card Number: - -
Expiry Date: -
Card Issuing Bank:
CBC Code (The four digit number on the left/right side of the card)
Company cheque ( for Malaysians only )
Cheque Number:
Cheque Issuing Bank:
Date of Transaction:
Local order ( for Malaysians only )
Local Order Reference No :
Telegraphic transfer ( T.T. )
T.T. Reference No:
T.T. Bank:
Date of Transaction:

Please Telegraphic Transfer (T.T) to the following:
Account Name : APDW 2010
Account No : 14710002621059
Bank Name : CIMB Bank
Bank Address : Plaza Damansara
Kuala Lumpur
Bank Tel : +603 2295 6100
SWIFT code : CIBBMYKL

* Please fax the T.T slip to the Secretariat
 

Terms and Conditions
  •

All payments should be made in USD. International delegates can make payment by Credit card or Telegraphic transfer. Malaysian delegates can make payment by Local cheque or Local order

  •

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.
Confirmation
 

- Registration will only be confirmed upon receipt of FULL PAYMENT.
- Upon receipt of the payment, the Congress Secretariat will send you a confirmation letter via email.
- Please bring along the confirmation letter and present it at the time of Registration at the Congress
Cancellation Policy
  •

Cancellation of registration must be made in writing to the Secretariat. Refunds will only be made after the Congress.
- Cancellation received on or before 1st May 2010 :   100% refund (minus an administration fee of USD50)
- Cancellation received between 2nd May 2010 and 15th August 2010 :   50% refund
- Cancellation received after 15th August 2010 :   No refund
I fully understand and agree to all the terms and conditions
 
   
 
 

Congress Secretariat: Console Communications Sdn Bhd
Suite 11.8, Level 11, Wisma UOA II, 21 Jalan Pinang, 50450 Kuala Lumpur, MALAYSIA
Tel: +603 2162 0566 Fax: +603 2161 6560 Email: info@apdw2010.org.my