MDA EVENING LECTURE SERIES REGISTRATION FORM MDC No. ______________________ (applicable to Malaysians only) NAME: _____________________________________________________________ INSTITUTION: _______________________________________________________ ADDRESS: _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ H/P No: ___________________ FAX No: _________________________ Email add: _______________________________________________________ ELS Date/Spekaer: _______________________________________________________ Please fax, scan/email your registration form to Malaysian Dental Association (details as per below) at least 4 days before the lecture date to confirm your participation. As lectures are limited to 50 participants each time & registration shall be on first come first served basis. Tel : 03 - 2095 1532 Fax : 03 - 2094 4670 Email : [email protected] Contact person: Ms Hannah Lim/Pn. Zainon Please note that e-certificates will be accessible on the MDA website within 2 weeks of the event. This complimentary programme is strictly for MDA members in benefit.
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