Intensive Course In Abdominal Radiology
19th -23rd September 1999

REGISTRATION FORM
Click to register online






 

The Secretariat
Intensive Course In Abdominal Radiology
Department of Radiology
School of Medical Sciences, USM
16150 Kubang Kerian, Kelantan.
Tel: 09-760-1170 Fax: 09-765-3370
e-mail: marahman@kb.usm.my
http://members.xoom.com/azman51/rad.html
http://members.tripod.com/PPIM/rad.html

Name:         ___________________________________________________________________

Address:     ___________________________________________________________________

                     ___________________________________________________________________

                    ___________________________________________________________________

Institution & Department: _______________________________________________________

Tel: ______________________ email: ______________ fax: _________________

Computer knowledge (please specify with grade)

Internet usage: (please specify purpose: e-mail, radiology CME Homepage, general topics, ...  )
              ___________________________________________________________________


Registration Fee
 
Professionals RM 100  
Postgraduate student  RM 100  
Auxillary staff, Student & technologist RM 50  

Payment
 
Cheque or Bank draft should be made payable to 
"Timbalan Bendahari USM"
Enclosed cheque No: __________ 
Bank: _____________

Accommodation
Participants are adviced to make their hotel reservations directly except for Perdana.

Hotel Perdana (booking through us to be eligible for price discount)
RM135.00 (single/double) + breakfast, tranportation to USM available
Jalan Mahmud, 15720 Kota Bharu. Kelantan Darul Naim. Tel: 09-7485000 Fax: 09-7478955

Hotel Ansar (An Islamic Hotel)
RM55, RM80, RM100, RM120.00 (single) - car park, air con, in house video, TV
Jalan Maju, 15000 Kota Bharu. Kelantan Darul Naim. Tel: 09-7474000 Fax: 09-7461150

Hotel Square Point: 09-747-3333
Standard single RM98, Deluxe RM108, Deluxe family RM148
Jalan Pengkalan Cepa, 15200 Kota Bahru. Kelantan Darul Naim.

Juita Inn: 09-744-6888 e-mail: hotel@tm.net.my
Superior single RM95, Deluxe RM135
Jalan Pintu Pong, 15000 Kota Bahru. Kelantan Darul Naim.
Hotel Mawar: 09-744-8888 Safar Inn: 09-747-8000
Sutera Inn: 09-744-1000
 Hostel:
House Officer hostel (only limited places available)
RM10.00 (single) maximun 5 persons
RM40.00 (twin sharing) maximun 4 persons

The reservation can be accepted for Hostel
Check-In date :  _____________
Check - Out    : _____________
 

Signature: ____________________________      Date: _____________