A l u m n i

30%discount

11th IMU-Hospital Tuanku Ja’afar Seremban MRCP PACES Preparatory Course

CONTACT PERSONMs Liong Siao Lin / Inthirah NarayananTel : +60 3 2731 7669 / +60 6 7677 798 ext 105Fax : +60 3 8656 8018Email : icl@imu.edu.my / inthirah_narayanan@imu.edu.my

Places for Mock Exam are strictly limited and are allocated on a fi rst - come fi rst - served basis.Places for Observer (Mock Exam only) are allocated to delegates who register for course without mock exam.Replacement of seat is strictly not allowed.Registration fees include lunch, refreshments and the event documents.

Jointly Organised Byy g

Hospital Tuanku Ja’afar SerembanMinistry of Health

REGISTRATION FEE (inclusive of 6% GST)

Course With Mock Exam RM2,500

Course Without Mock Exam RM1,800

Observer (Mock Exam only) RM400

http://imu.my/icl-cpd

Features• Intensive course of 2 days followed by mock examination.

• Faculty includes experienced examiners from various local universities and Ministry of Health hospitals.

• Format according to MRCP PACES Stations - Respiratory System - Abdominal System - Cardiovascular System - Nervous System - Brief Clinical Consultation (New Station 5) - History, Communication Skills & Ethics - Mock Exam & Feedback

DATE : 18-20 September 2015 (Friday - Sunday)VENUE : IMU Clinical School, Seremban Day Care Centre, Hospital Tuanku Ja’afarCourse Director : YBhg Prof Dato’ Dr (Mrs) ST Kew

IMU Clinical School, Seremban

SCAN FOR MORE

REGISTRATION FORM

Course With Mock Exam RM2,500

RM1,750 (Alumni)

Observer (Mock Exam only) RM400

RM280 (Alumni)

Course Without Mock Exam RM1,800

RM1,260 (Alumni)

REGISTRATION FEE

11th

IMU-

Hosp

ital T

uank

u Ja

’afa

r Ser

emba

n M

RCP

PACE

S Pr

epar

ator

y Co

urse

CANCELLATION POLICY

1. Any cancellation of registration must be made in writing to the Secretariat of 11th IMU-Hospital Tuanku Ja’afar Seremban MRCP PACES Preparatory Course.2. There will be full refund of registration fee for cancellation made by 18 July 2015.3. There will be a 50% refund of registration fee for cancellation made by 18 August 2015.4. There will be a 30% refund of registration fee made by 4 September 2015.5. There will be no refund of registration fee for cancellations made after 11 September 2015.6. The Organiser reserves the right to cancel or change the topic of the workshop, if for whatever reasons beyond its control, the workshop cannot be held as scheduled or

the topics need to be altered.

DECLARATION AND AUTHORISATION

1. I confi rm that the above information is correct and I will inform IMU when there is any change to this information.2. I have read, understood and consent to the processing of my personal data as set out in the enclosed Privacy Notice.

MODE OF PAYMENT

Please tick your option:

Cash

Cheque* (for Malaysian Banks only)

Credit Card

I hereby authorise the processing of my card for the sum of (USD/RM):

Please complete the following sections. These details are required for security purposes.

Type of Card: VISA MASTERCARD Issuing Bank:

Cardholder’s name (as it appears on the card):

Card Number: Card Expiry Date: / (MM/YY)

Card Security Code (3 digits found on reverse VISA / MASTERCARD) Bank Draft* Bank of Issue: Date: Total Amount (USD/RM):

* Payable to IMU Education Sdn Bhd

Signature Date

Name: Nationality:

Gender: Male Female Title: Dr Other:

Organisation:

Department: Position:

Tel No: ( ) Fax No: ( ) Mobile Phone No:

Address:

Postcode: City: State:

Please indicate whether this is your offi ce or home address: Organisation Home

Email:

Organisation’s Website (if any):

Dietary Needs/Preference: Vegetarian Non-Vegetarian

Are you an IMU Alumni member? Yes No If yes, please provide your ID number:

FOR MORE INFORMATION, KINDLY CONTACT:Ms Liong Siao Lin / Inthirah Narayanan 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, MalaysiaTel: +60 3 2731 7669 / +60 6 7677 798 ext 105 Fax: +60 3 8656 8018Email: icl@imu.edu.my / inthirah_narayanan@imu.edu.my http://imu.my/icl-cpd

DISCLAIMER:The organiser reserves the right to make such alterations to the programmes as circumstances dictate and will not accept responsibility for any errors, omissions or changes made to the speakers’ information. The views and opinions expressed by the speakers at this workshop are not necessarily the views and opinions of the organiser.