22 nd & 9th ICHCM Malaysia 2014
Name:.................................................................................
Accompanying person (name)......................................................
Full Postal Address:....................................................................
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Tel. Office.............................Res:........................................
Mobile:...............................................................................
E mail:...........................................................................
Interest:........................................................................
Note: You may print and photocopy this form and use as official registration form.
Registration before 8th August 2014
Full Delegates US $ 250.00 ( sharing room)
Accompanying person: US$ 200.00 ( sharing room)
Single Occupancy Room: US$ 350.00
( Room for 3 days 2 nights )
Conference Only: US 200.00 ( no accommodation)
After 8 August 2014
Full delegates US$ 300.00
Accompanying person: US$ 250.00
Single Occupancy Room: $ 400.00
Conference Only : US$ 250.00 ( no accommodation)
The payment including: Conference fee, 3 days 2 nights Hotel accommodation, tea breaks and lunchs
Conference bag, Papers & Booklet will be provided.
Kindly pay as soon as possible or before 20th July 2014
Mode of Payment by
Direct telegraphic transfer t.t. or Bank Draft in favor of
Name: The Faculty of Homeopathy malaysia
Name of Bank: Al Rajhi Bank, Shah Alam, Selangor, Malaysia.
Account No: 12300-1881 311 510
Bank Swift Code: RJHIMYKL
For fast and easy and safe payment, kindly pay through Western Union Money Transfer in favor of
Nik Fairuz Hakim bin Nik Omar
Please sent your payment slip / Bank Draft / Western Union Code Number direct to:
Secretariat ICHC 2009
Att: Dr Nik Fairuz Prof Dr Nik Omar or Prof Mohd Nasir
- The Faculty of Homeopathy MalaysiaNo.29, Tingkat 1, Jalan Peniaga, U1/34, Glenmarie Industrial Park, 40150 Shah Alam, Selangor, Malaysia.
Tel: +6013-931 4166
Fax No: 03-55693856
or