Venue : Auditorium Pusat Perubatan UKM (PPUKM), Cheras

Date : 26 March 2016 (Saturday)Time : 08.00 am - 03.30 pm

Name :

I/C No :

Designation :

Department :

Organization :

Address :

Tel. No. :

Name :

I/C No :

Designation :

Department :

Organization :

Address :

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Total Participant : ___________ person

Total RM : ____________

RADIATION PROTECTION SEMINAR 2016

Fax No. :

Fax No. :

REGISTRATION FORM

* Please photocopy this form if the participants more than 2 person

* Contact Person: En Hairul (Radiology Department,PPUKM): 03-9145 6186 (Email: mhfa79@ppukm.ukm.edu.my)

REGISTRATION FORM