registration form

YES! Please register the following for the program on:

# Name Designation Email 1. 2. 3. 4. 5.

Submitted by

Name Position Email

Organization Address 1 Address 2 State Country Phone Fax Org Email

Select your payment method By Cheque / Bankdraft Cheque  Draft No. for RM being payment for  participant(s) made in favour of "RAYMA SDN BHD" will be sent to: 2B Jalan SS24/13, Taman Megah, 47301 Petaling Jaya, Selangor Darul Ehsan, MALAYSIA. a By Credit Card Select a credit card..... MasterCard Visa for RM Card Number Expiry Date (mm/yyyy) Name on Card a Additional remarks/questions? a ALL SET? Gentle Reminder: 1.  Please ensure your contact numbers and email address above are correct. 2.  All bookings will be confirmed via your email address. 3.  You may like to print a copy of this page for your reference. 4.  Need fast answers, kindly contact Ms. Pat Lu at +60.3.7804.4666 (Mon-Fri, 9am-6pm) If the above information is correct,  If you wish to change any entry or start over,