REGISTRATION FORM

Today's Date:

Name :

Address :

Telephone :

Fax :

Email :

I wish to ( tick appropriate ) :

Attend the 27th Scientific Conference of NSM

Attend the NSM Annual Dinner (25 May 2012)

Make a presentation entitled

Registration fee *

Will send Cheque/Money Order/Postal Order for RM : Cheque No.

Paid by Cash RM :

Government LPO / guarantee letter from Dept Heads

Abstract of Paper

Email to President Email

Shall submit before 26 April 2012

Not applicable

Late fees applicable: after 15 May 2012

(All participants, including oral / poster presenters, must register for the conference and pay the appropriate fees. Cheques / money orders / postal orders should be made payable to the "Nutrition Society of Malaysia". Outstation Cheques should include required bank charges)

* Please mail your Cheques / LPO / guarantee letter from Department Heads together with printout of this online registration to

Dr Tee E Siong President, NSM 46 Jalan SS22/32 47400 Petaling Jaya Selangor D.E. Tel: 019-321 1788 Fax: 03-7728 7426	Or	Prof Dr Norimah A Karim c/o Dept of Nutrition & Dietetics Faculty of Allied Health Sciences Universiti Kebangsaan Malaysia 50300 Kuala Lumpur Tel: 03-9289-7247 Fax: 03-2694-1296
**Please print before clicking "Submit"