REGISTRATION
 
Please complete the following registration form. Make sure to include ALL contact information (email address, mailing address, telephone & fax) to ensure receipt of your Registration Confirmation Email. All registration MUST be accompanied with payment. Registration without payments will not be processed.
 
A. PERSONAL DETAILS
Title  
Name On Badge   * Limited to 15 letters only
Full Name as per IC / Passport  
IC Number  
Institution / Hospital  
Correspondence Address  
City  
Postcode  
Country  
Letter for Visa Application  
Yes No
Mobile Number   (country code)(area code)(telephone no)
Fax   (country code)(area code)(fax no)
Email  
     
Profession  
Orthopaedic Surgeons GP Allied Health Professionals
Student Sports Physicians Coaches
Physiotherapist Sports Science Practitioners Trainers
Others  
   
Dietary Requirement  
Vegetarian Non-Vegetarian
     
B. INSTITUTION / COMPANY SPONSOR DETAILS
* If you are registering yourself under LPO or Letter of Guarantee Letter, part B details are compulsory to fill in.
* Institution / Company Sponsor details are compulsory if you are a sponsor and would like to be kept updated on this registration.
Contact Person's Name  
Institution / Company Name  
Mobile Number  
Office Number  
Email  
     
C. REGISTRATION FEES
     
Please select the relevant option. The registration fees include registration for Ultrasound and Taping Workshop. Please refer to the scientific programme for further details on the workshops.
DATES CATEGORY MASM Member
(Life Member & Ordinary members in good standing only )		 Non-MASM Member (Malaysian) ASEAN Countries Other Non-ASEAN Countries Malaysian Student Foreign Student
28th & 29th Nov 2015
Conference		 Early Bird
before 31st Aug 2015
   RM 800
   RM 1100
   USD 330
   USD 470
   RM 500
   USD 250
Post Early Bird
between 1st Sept to 14th Nov 2015
   RM 1100
   RM 1400
   USD 410
   USD 570
   RM 800
  USD 300
Onsite
15th Nov 2015 to during conference
 RM 1400
 RM 1700
 USD 490
 USD 670
 RM 1,100
 USD 350
I am registering for Please select
  • ASEAN Countries are Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam
Full Day Lectures SELECTED
Half day Lectures with Ultrasound Workshop (limited places) FULL
Half day Lectures with Taping Workshop (limited places) FULL
Workshops have limited places. Registration for workshop is based on whoever registers for the workshop first. Only online registration applies. If you would like to attend the Workshop, please select the workshop during online registration.
 
Terms and Conditions
If your membership detail is not filled in or is no longer current, your registration will automatically be processed as a Non-MASM Member.
If you wish to check your status, please contact MASM secretary (Mr.Udesh) at 017 686 1168 or sportsmed.my@gmail.com
If you are a Malaysian Student, please attach a letter from your University Dean or Head of Faculty on University letterhead.
If you are a Foreign Student, please attach proof from your University Dean or Head of Faculty on University letterhead.
     
TOTAL AMOUNT DUE  
     
D. PAYMENT MODE
Please Select Payment Mode  
Bank-in Cash or Cheque Letter Of Guarantee
Online Transfer or Telegraphic Transfer LPO
     
Attach Proof    [ max file size : 20MB ]
    Please attach scanned document of either bank-in cash, bank-in cheque or online transfer slip or telegraphic transfer slip.
    *Please make sure the name of the attachment does not contain special characters.
     
Attach Student Proof    [ max file size : 20MB ]
 
All payments are to be issued in favour of "Malaysian Association of Sports Medicine"
Bank   CIMB Berhad
Account No   8007412959
Bank Address   27, Jalan 52/2, Bandar Baru Petaling Jaya, 46050 Petaling Jaya, Selangor
Bank Branch Telephone   03-79553806
Swift Code   CIBBMYKL
 
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:
Cancellation on or before 30th September 2015 : 95% refund
Cancellation after 1st October 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 email to secretariat@malaysiansportsmed.org		   CONFERENCE SECRETARIAT
MALAYSIAN ASSOCIATION of SPORTS MEDICINE
c/o BLOOM COMMUNICATIONS
P1-2-1, Andalucia, Pantai Hill Park,
Jalan Pantai Permai, Bangsar South,
59200 Kuala Lumpur, Malaysia.
Tel: +603 2242 0902 /+6016 335 0036
Email: secretariat@malaysiansportsmed.org
Website : www.malaysiansportsmed.org
Fax: +603 6207 6795
     
 
 
 
 
CONTACT US  
MALAYSIAN ASSOCIATION of SPORTS MEDICINE
c/o Bloom Communications P1-2-1, Andalucia,
Pantai HillPark, Jalan Pantai Permai,
59200 Kuala Lumpur, Malaysia
   
Contact Number +603 2242 0902
Fax Number +603 6207 6795
Email Address secretariat@malaysiansportsmed.org
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