Delegate Details
* Mandatory field
Title: * Prof     Dr     Mr     Mrs     Ms     
Full Name: *
Affiliated Organisation /
Institution : *
Address : *
 
State : *
Country : *
Postal Code : *
Tel : *
Mobile :
Fax : *
E-mail : *
Are you vegetarian? *  Yes   No
Do you want to attend
the Congress Dinner? * 		 Yes   No

* The Congress Dinner is limited to only 300 registered delegates.
Please obtain your dinner ticket at the registration counter. Tickets are given on first-come first-served basis
 

Registration Fee
Category Early Registration
On or before
1st April 2009		 Normal Registration
after 1st April 2009
International Delegates
RM 1200
RM 1500

Local Delegates
RM 1000

RM 1000
Trainees/Nurses/Allied Health
RM   600
RM   600

Day Registration

RM   400

RM   400
Accompanying Person (RM 75)
Name :
* USD1 is approximately RM3 at the time this registration form is printed. However, the actual registration fee is subject to the conversion rate (which will be informed by the Congress Secretariat) when the payment is made.
 

Payment
My total payment of RM to be made through:
Master or Visa card:
I have authorised the Organiser of the 20th Video Urology World Congress to debit the total amount of
RM  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 Organiser of the 20th Video Urology World Congress to debit the total amount of
RM  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)
Banker Cheque/Banker Draft ( for Malaysians only ) *
Cheque Number:
Cheque Issuing Bank:
Local Order ( for Malaysian only ) *
Local Order Reference No :
TelegraphicTransfer ( T.T. ) *
T.T. Reference No:
T.T. Bank:
Date of Transaction:

 

Please Telegraphic Transfer (T.T) to the following:
Account Name : 20th Video Urology World Congress 2009
Account No : 514 3567 26845
Bank Name : Malayan Banking Berhad
Bank Address : Wisma Genting Branch
Jalan Sultan Ismail
Kuala Lumpur
Bank Tel : +603 2039 3117/3119
SWIFT code : MBBEMYKL
 

Terms and Conditions
  •

All registration fees will be charged in RM. Payment can be made by bank draft, telegraphic transfer or credit card.
  •

* Please fax the Local Order/TT slip/proof to the Secretariat
  •

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 Conference.
Confirmation
 

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

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 1st April 2009 :   100% refund (minus admistration fee of RM200)
- Cancellation received between 2nd April 2009 to 2nd May 2009 :   50% refund
- Cancellation received after 3rd May 2009 :   No refund
 
Paid registration fee is not refundable after the stipulated dates for whatever reasons, including failure of obtaining visa.
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: videourology@console.com.my