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10 th LANGKAWI INTERNATIONAL TEMPORAL BONE COURSE
For further enquiries
Email:
[email protected] Dr Mohd Ayzam Ahmad Dr Khaw Bee Lian Dato’ Dr Siti Sabzah Mohd Hashim Prof Dato’ Dr Lokman Saim Prof Dr Goh Bee See
Otology Masterclass by the MASTERS
&
OTOLOGY MASTERCLASS
PROGRAMME HIGHLIGHTS
•Cutting Edge Surgery • Detailed Teaching •Top Class Video Coverage •Finer Aspects Of Surgical Techniques •Endoscopic OTOLOGIC Surgery •Otology implants •Include Minimal Access Stapedotomy, •Stapes Surgery& Laser •Revision Surgeries •Obliteration Technique For Cholesteatoma, • Blind sac procedures, • Variety Of Grafting Technique •Intact Canal Wall Tympanoplasty •And more…
5th – 7th MARCH 2018
OMBAK VILLA International FACULTY
Prof Dato ‘ Dr Lokman Saim (Malaysia) Prof Dr Jan Edze Veldman (The Netherlands) Prof Dr Hans Peter Zenner (Germany) Prof Dr Herman Jenkins (USA) Prof Dr Rafael Urquiza (Spain) Prof Dr Stephen O’Leary (Australia)
REGISTRATION FORM LANGKAWI INTERNATIONAL TEMPORAL BONE COURSE
Name (in BLOCK LETTER)
Title (circle where applicable) Professor | Dr | Mr | Mdm | Ms
Institution
Mailing Address
Contact Number (OFF) (HP)
Fax Number (if any)
e-mail address
Please tick one box only EARLY BIRD
(BEFORE 5TH FEB)
LATE REG (AFTER 5TH FEB)
DELEGATES
SPECIALIST
TRAINEE
INTERNATIONAL
* fees does not include accomodation
RM 650
RM 500
USD 200
RM 750
RM 550
USD250
I enclose payment by * cheque / bank draft / telegraphic transfer with the amount of RM ------------------------------NO:----------------------- * circle where applicable and send a copy of payment proof & form,
by fax +6047407335 or e-mail to : [email protected]
Date Signature
Payment can be made by cheque / bank draft / telegraphic transfer, payable to
“PERSATUAN PENDIDIKAN ORL , AUDIOLOGI DAN PERTUTURAN HOSPITAL SULTANAH BAHIYAH”
Maybank A/C No. 552022621704 (Swift Code: MBBEMYKL)
BEFORE 20TH FEBRUARY 2018
Please tick one box only Early Bird
BEFORE 5TH FEB)
LATE REG (AFTER 5TH FEB)
DISSECTOR
LOCAL SPECIALIST
INTERATIONAL SPECIALIST
LOCAL ENT TRAINEEE / MASTER
INTERNATIONAL ENT TRAINEE
* fees does not include accomodation
RM 2300
USD 800
RM 2000
USD 500
RM 2500
USD 900
RM 2200
USD 600
I enclose payment by * cheque / bank draft / telegraphic transfer with the amount of RM ------------------------------NO:------------------------
circle where applicable and send a copy of payment proof & form , by fax +6047407335 or e-mail to : [email protected]
Date Signature
Payment can be made by cheque / bank draft / telegraphic transfer, payable to
“PERSATUAN PENDIDIKAN ORL , AUDIOLOGI DAN PERTUTURAN HOSPITAL SULTANAH BAHIYAH”
Maybank A/C No. 552022621704 (Swift Code: MBBEMYKL)
BEFORE 20thTH FEBRUARY 2018
Suggested accomodations
REGISTRATION FORM OTOLOGY MASTERCLASS by THE MASTERS
Name (in BLOCK LETTER)
Title (circle where applicable) Professor | Dr | Mr | Mdm | Ms
Institution
Mailing Address
Contact Number (OFF) (HP)
Fax Number (if any)
e-mail address
Walking Distance
Ombak villa +6049558181
Langkawi Lagoon +6049558181
Kuala Melaka Inn +6049557007
Perdana Beach Resort +6049559199
5 Minutes Drive
Century Langkasuka Resort
+6049527000
Century Helang Resort
+6049553030
Walking Distance
Ombak villa +6049558181
Langkawi Lagoon +6049558181
Kuala Melaka Inn +6049557007
Perdana Beach Resort +6049559199
5 Minutes Drive
Century Langkasuka Resort
+6049527000
Century Helang Resort
+6049553030
Suggested accomodations
