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["REGISTRATION FORM"]
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["Event: PhAMA - Monash HE & HTA Program 2017"]
["Date: 25th-26th September, 2017 "]
["Venue: Sunway Clio Hotel, Jalan PJS 11/15, Bandar Sunway, 47500 Petaling Jaya, Selangor, Malaysia"]
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["No","Title","Name (same print in certificate)","Designation","Company","Email ","Contact No.","Vegetarian ","Remark"]
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["Payment: "]
[null,"By Cash/Giro Transfer/Instant Transfer (please attach payment details and email us)"]
[null,"By Cheque (please attach cheque number)"]
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["NOTE:"]
["Registration fee for member to this program will be RM1,800/per participant (Non Member registration fee RM1,950).  Kindly forward your registration and payment to PhAMA secretariat at phama@phama.org.my before 8th September 2017(Limited seats only,maximum 30 participants & registration will be on a first-come, first-served basis). No refund will be given upon cancellation.  However, a replacement will be accepted with the consent of the Secretariat.   *All Cheques payable to Pharmaceutical Association of Malaysia (Public Bank A/C: 3133949602, Swift Code: PBBEMYKL)"]