*Asterisks
field are compulsory
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| Gender* |
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| Title* |
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| First Name* |
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| Family Name* |
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| Preferred Name & Title to be Printed on
Certificate* |
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| Institute | Organisation* |
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| Designation* |
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| Medical License Number* |
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| Mailing Address* |
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| City* |
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| State* |
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| Zip Code* |
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| Country* |
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| Telephone* |
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| Telefax* |
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| Email* |
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| Website* |
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| I will be attending: |
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Level 1 - Aesthetic Medicine Certificate Course
(20 - 22 June 2008) Malaysia (AAAM Member:
US$2,100, Non-Member: US$2,200) |
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Registration fees include
- Scientific session and workshops
- Coffee breaks and luncheons during the course
- Products/materials used for hands-on sessions such
as Botulinum Toxin A, Skin Fillers, Chemical Peels etc
- Delegate Bag & Lecture Notes
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| Payment Method |
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Credit Card (Click
here to enter your credit card details)
(4%
administrative charges applicable for payment via credit card) |
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Details will follow by fax (Click
here to download form) |
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Bank Draft
- Bank draft made payable to
Ezyhealth Conferences & Events International Pte Ltd.
- Bank draft must include bank charges.
Mailing Address for Bank Draft:
Ezyhealth Conferences &
Events International Pte Ltd
53A Science Park Drive, The Faraday,
Singapore Science Park 1,
Singapore 118234
Attention: AAAM Secretariat
Telephone: (65) 6395 9464
Fax: (65) 6395 9365
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| Cancellation Policy |
All cancellation received before
or on 11 June 2008 will be subjected to a 30%
administration fee. No cancellation will be accepted from
12 June 2008. The Organiser reserves the right to cancel
or alter the content and timing of the programme or the identity
of the speakers. In the event that the meeting is cancelled by
the Organiser, the registration fee (less bank charges) will be
refunded. Registration is confirmed only when submitted with
payment.
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| Hotel Accommodation |
Hotel Accommodation @ The Ritz-Carlton Kuala Lumpur:
Deluxe Room (Single/Double Occupancy with daily breakfast):
MYR 430++ / room / night
* all guestrooms come with complimentary high speed
internet access
For more information regarding hotel accommodation,
please contact:
AAAM Secretariat
Ezyhealth Conferences & Events International Pte Ltd
Tel: (65) 6395 9464
Email:
asiaaesthetic@ezyhealth.com
- Kindly send your hotel reservation
requests to AAAM Secretariat in order to enjoy the above
negotiated group room rates
- Rooms and rates are subject to
availability
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