17th Meeting of Consortium for Globalization of Chinese Medicine (CGCM)

Malaysian Institute of Pharmaceuticals & Nutraceuticals (IPharm), National Institutes of Biotechnology Malaysia (NIBM)

Kuching, Sarawak, 8th- 10th August 2018

REGISTRATION FORM

Please send your registration form to on or before July 16,2018 (Monday).

Personal Information
Title: / □Prof □Dr □Mr □Mrs □Ms □Others:
First name : / Last name:
Position :
Department:
Institution / Company:
Mailing address:
Telephone: / Fax:
E-mail:
Name and contact details (phone, fax, e-mail) of your assistant
I am registering as
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□ / Member - Institutional/ Industrial Affiliate Representative (3 Free Participant Quotas)
Member – 4th participants and onwards
Travel Grant Applicant
Invited Guest/ Session Chairman/ Session Co-chairman/ Session Panelist
Students and Post-doctoral Fellows
Non-Member –New Membership Applicant
Non-Member-Institute
Non-Member- Company/ Exhibitor
Others (please specify): ______
Registration fee / On or before May 31, 2018 / After May 31, 2018
3 free participant quotas from member institutes / □USD 00.00 / □USD 00.00
Invited Guest/ Session Chairman/ Session Co-chairman/ Session Panelist/ Travel Grant Applicant / □USD 00.00 / □USD 00.00
4thparticipant andonwards / □USD200 / □USD250
Non-Members / □USD300 / □USD350
Students and post-doctoral fellows / □USD100 / □USD150
TOTAL: / USD
Payment
□Wired Transfer
Payee/’s Name : National Institutes of Biotechnology Malaysia
Account No: 5660 – 1061 – 3627
Bank Name: Malayan Banking
Swift Code : MBBEMYKL
Bank Address: R13& R15, Bangunan Annexe, Dewan Persidangan Putrajaya, Percint 3, 62100 Putrajaya, Malaysia.
**Please indicate the payment reference “CGCM2018”, andnote that all payments should be made net of charges by the payees. If any bank charges are deducted, organisers are allowed to charge the payees after arrival in cash (USD).
**Admission to the Meeting will be granted only if the organizers have received the registration fee. Delegates who have made late payments should bring a copy of the receipt to the congress. Failure to show this receipt on request gives the organizers the right to charge the full amount prior to admission.

CANCELLATION TERMS:

Once paid, registration fee is non-refundable.

Signature Date

For inquiries, please contact IPharm, NIBM office, via

email: telephone: +604-6521200 orfax: +604-6563020

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