EMAS 2025 - Participant Registration

GROUP REGISTRATION

Please fill-up registration information for all 5 participant

Participant 1 Title Full Name NRIC / Passport No Gender

Designation Organization E-mail

Country Code

Phone No.

Country

Meal Type

Medical Officer Early Bird : MYR 400.00 x 1 pax Malaysian Delegates Conferment Day (Day 1 Only): MYR 400.00
Total: MYR 400.00

PAY WITH

Local Participant can pay with Local Purchase Order (LPO) to

No. MOF

:357-0002401216

No. eP

:eP-1400M000T

Nama

:ACADEMY OF MEDICINE OF MALAYSIA

No. Pendaftaran Perniagaan

:PPM-001-14-07041967

Other payment option include bank transfer to
* Specify 'EMAS 2025 Registration' as transfer detail

Organization Name

:COLLEGE OF EMERGENCY PHYSICIANS, ACADEMY OF MEDICINE OF MALAYSIA

Account No

:3987324409

Name of Bank

:Public Bank Berhad

Branch

:Jalan Ipoh Branch

Branch Code

:041

Address of Bank

:Public Bank Berhad
Wisma Yap Ka
No 480, Batu 3
Jalan Ipoh, 51200 Kuala Lumpur

Swift Code

:PBBEMYKL (or PBBEMYKL041 for international transfer)

Upload Proof of Payment (PDF/JPG/PNG max file size is 2MB)