REGISTRATION FORM – INTERNATIONAL WORKSHOP ON ENSURING QA IN HEMATOLOGY: FUNDAMENTALS & BEYOND
SALUTATION
*
PROF DR.
ASSOC. PROF DR.
DR.
MR.
MS.
NAME (AS PER ID)
*
In Capital Letter
EMAIL
*
DESIGNATION
*
Medical Laboratory Technologist
Medical Laboratory Scientist/Science Officer
Laboratory Manager
Specialist/Pathologist
Sales Representative/Executive
Others
CONTACT NUMBER
*
INSTITUTION/HOSPITAL/COMPANY
*
CATEGORY
*
Public/Government Hospital
University Hospital
Private Hospital/Company
Others
REGISTRATION FEES
*
test
Specialist [MMLHS Member]
Specialist [MMLHS Non-Member]
MLT/MLS/SO [MMLHS Member]
MLT/MLS/SO [MMLHS Non-Member]
Total
RM 0.00
Phone
This field is for validation purposes and should be left unchanged.
Δ