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10th-12th Oct 2017

Hotel Pullman Kuching


Sarawak, Malaysia

Ageing
Challenges, successes &
the journey ahead
Registration Form
Please return this registration form together with payment document to the Secretariat via e-mail or fax. All fields
are mandatory.

Title & Name

Name on Badge

Organisation
& Address

E-mail

Contact No.

Meal Preference Vegetarian Non-Vegetarian

Registration Fee (Please tick wherever appropriate)


Delegates Student / MHAS Members

Local Delegates RM500.00 RM400.00


Early Bird
Registration ASEAN Delegates US$300.00 US$250.00
Till 31st July 2017

International Delegates US$500.00 US$400.00

Local Delegates RM650.00 RM500.00


Normal
Registration ASEAN Delegates US$400.00 US$350.00
After 31st July 2017

International Delegates US$650.00 US$500.00

Payment Method (Please tick wherever approprite)

Cheque Local Order Direct bank-in Telegraphic Transfer

Others (Please specify)

Banking Information
Please make all cheques payable to the “Malaysian Healthy Ageing Society”
if you are paying via telegraphic transfer, direct bank - in or online transfer, please remit as follows :

Name of bank RHB Berhad Name of account Malaysian Healthy Ageing Society
Account number 26416000002456 Swift code RHBBMYKL

Malaysian Healthy Ageing Society (Registrar of Societies No.1384)


Unit No: 2-56, 2nd Floor Shop Office, Scott Garden, 289, Jalan Klang Lama, 58200 Kuala Lumpur, Malaysia.
T | +6012 364 6109 F | +603 2726 8902 E | info@healthyageing.org W | www.acha2017.com

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