REGISTRATION FORM

DETAILS
Name
Pro fession
PEPC/PE/GE/ET/IOW Reg.No
Company / Organization
._______ ___.

Address

Mobile No.
Phone No. (Office)
Fax. No
Email
Dietary
Vegetarian
Non-Vegetarian

LOCATION

» Kuala Lumpur 4.7.2018 Wednesday » Johor Bahru 2.9.2018 Sunday

PULLMAN HOTEL, BANGSAR *TBA

» Kuching, Sarawak 28.7.2018 Saturday » Kuala Terengganu, 24.9.2018 Monday

*TBA *TBA

» Kota Kinabalu,Sabah 30.7.2018 Monday » Miri, Sarawak 15.10.2018 Monday

*TBA *TBA

» Pulau Pinang 13.8.2018 Monday

*TBA

*Date and Venue Subject To Changes

Closing Date :
Payable to LEMBAGA JURUTERA MALAYSIA 1 Week before event/ subject to number of participants

____.,.
Online Bill Payment : Completed form with payment/ transaction slip
www.mybank2U.com.my Dated to be fax to 03-26925017 or

____.,.
www.cimbclicks.com.my Dated email to ppc@bem.org.my or
1-----1 post or courier to :
www.rhbbank.com.my Dated
Local Order L/O No
LEMBAGA JURU TERA MALAYSIA
1-----1 TINGKAT 17, BLOK F, IBU PEJABAT JKR
Money Order/Postal Order No.
JALAN SULTAN SALAHUDDIN
Cheque No.
50580 KUALA LUMPUR