A. DELEGATE DETAILS
* Mandatory field
Title: Prof     Dr     Mr     Mrs     Ms    
Name: *
(Name to be printed on name badge)
Gender: Male     Female
Nationality : *
Company Name: *
Address : *
 
Postcode : *
State :
Country : *
Telephone : *
Mobile :
Fax :
Email : *
AIHA / MIHA Member /
Organisational Membership No : *
 
B. REGISTRATION DETAILS
Promo Code :
Category
Early Registration
(Until
19th September 2014)
Advanced Registration
(From 20th September -
17th October 2014 )
Onsite Registration
(18th October 2014 -
Onsite)
Pre-Conference Courses (PDC) - 4th November (additional fees)
PDC 1 - (AIHA/MIHA Member/
Organisational Members)
Professional Development Course 1 -
Bayesian Decision Analysis and Professional Judgment in Exposure Assessment
RM 1250 / USD 390
RM 1410 / USD 440
Availability based on
PDC seats remaining
PDC 1 - (NonMember)
Professional Development Course 1 -
Bayesian Decision Analysis and Professional Judgment in Exposure Assessment
RM 1480 / USD 460
RM 1640 / USD 510
Availability based on
PDC seats remaining
PDC 2 - (AIHA/MIHA Member/
Organisational Members)
Professional Development Course 2 -
Noise Exposure Assessment –
Sampling Strategy and Data Acquisition
RM 1250 / USD 390
RM 1410 / USD 440
Availability based on
PDC seats remaining
PDC 2 - (NonMember)
Professional Development Course 2 -
Noise Exposure Assessment –
Sampling Strategy and Data Acquisition
RM 1480 / USD 460
RM 1640 / USD 510
Availability based on
PDC seats remaining
PDC 3 - (AIHA/MIHA Member/
Organisational Members)
Professional Development Course 3 -
Principles of Industrial Ventilation
Systems Design
RM 1250 / USD 390
RM 1410 / USD 440
Availability based on
PDC seats remaining
PDC 3 - (NonMember)
Professional Development Course 3 -
Principles of Industrial Ventilation
Systems Design
RM 1480 / USD 460
RM 1640 / USD 510
Availability based on
PDC seats remaining
Conference Registration Fees for 5th - 6th November
Full Registration - (AIHA/MIHA Member/
Organisational Members)
Malaysia + developing countries *
RM 1590 / USD 495
RM 1750 / USD 545
RM 1910 / USD 595
Full Registration - (NonMember)
Malaysia + developing countries *
RM 2230 / USD 695
RM 2490 / USD 775
RM 2810 / USD 875
Full Registration - (AIHA/MIHA Member/
Organisational Members)
Out of country
RM 2550 / USD 795
RM 2800 / USD 875
RM 3130 / USD 975
Full Registration - (NonMember)
Out of country
RM 2870 / USD 895
RM 3130 / USD 975
RM 3450 / USD 1075
Joining PDC only
RM 0 / USD 0
 
a. The PDC Fee include full day course, handout materials, morning and afternoon tea/coffee breaks, luncheon and certificate points.
b. The Full Registration Fee includes admission to all sessions (Except PDC's), coffee breaks, lunches, speaker handout materials, exhibition poster, welcome networking reception and certification points.
*. List of developing countries eligible to receive discounted registration rates :
http://www.isi-web.org/component/content/article/5-root/root/81-developing
 
C. PAYMENT DETAILS
My total payment of RM / USD to be made through:
Master or Visa card:
I authorise Console Communications Sdn Bhd to debit the total amount of RM  from my credit card for the settlement of the above mentioned fees.
Name of Card Holder:
Card Number: - - -
Expiry Date: -
Card Issuing Bank:
CBC Code (The last three digits on the reverse side of your card)
AMEX card:
I authorise Console Communications Sdn Bhd to debit the total amount of RM from my credit card for the settlement of the above mentioned fees.
Name of Card Holder:
Card Number: - -
Expiry Date: -
Card Issuing Bank:
CBC Code (The four digit number on the left/right side of the card)
Company Cheque ( for Malaysian only ) *
Cheque Number:
Cheque Issuing Bank:
Date of Transaction:
For Malaysian delegates who wish to make payment via Local Cheque, please email to Ms. Moon Wong at aiha.reghot2014@mci-group.com or call at +603-2162 0566
Local Order ( for Malaysian only ) *
Local Order Reference No :
For Malaysian delegates who wish to make payment via Local Order, please email to Ms. Moon Wong at aiha.reghot2014@mci-group.com or call at +603-2162 0566
TelegraphicTransfer ( T.T. ) *
T.T. Reference No:
T.T. Bank:
Date of Transaction:
Amount: USD
*Important Note: Please scan your TT slip and email to the Conference Secretariat for verification.

 
Telegraphic Transfer is to be made to the following Conference bank account:
Account Name : American Industrial Hygiene Association
Account No : 202957802
Routing No : 061000104
Bank Name : SunTrust Bank
Bank Address :

9401 Lee Highway, Fairfax, VA 22031 USA

SWIFT code : SNTRUS 3A
 
D. TERMS AND CONDITIONS
Credit Card payments must be made in RM. Telegraphic Transfer must be made in USD.
Please note that all related bank charges, financial charges or credit card commission (5%) are to be borne by the delegates and are not to be deducted from the fees payable to the Conference .
Your registration confirmation email will include method of payment and total amount paid and will serve as your receipt. Official receipts will only be provided upon request.
Confirmation
 

- Registration will only be confirmed upon receipt of FULL PAYMENT.

- Upon receipt of the FULL payment, the Secretariat will send you a Confirmation Letter via email.

- Please bring along the Confirmation Letter and present it at the time of registration at the Conference .

Cancellation Policy

Cancellation of registration must be made in writing to the Secretariat. Refunds will only be made after the Conference .

- Cancellation deadline: 1st October 2014 Administrative fees will be assessed as follows:
      Full conference before 1st October 2014 (USD 150)
      PDC Courses before 1st October 2014 (USD 100)
- Cancellation received after 1st October 2014 : No refund

Telephone cancellations are not accepted. To be considered for a refund, please send a written request to the secretariat.

* Paid registration fee is not refundable after the stipulated date for whatever reasons, including failure of obtaining VISA.

I fully understand and agree to all the terms and conditions
 
1. Age Group :
2. Industry of your Organization :
3. Number of Employees :
4. Plan to make / influence product purchase of :
5. Best reflects my decision making is :
6. Plan on recommending/buying products within
7. Product interests
Aerosol Technology Asbestos Abatement Communication/Training Confined Space
Environment Ergonomics Hearing Conservation Indoor Air Quality
Ionizing Radiation Laboratory Health and Safety Protective Clothing Protective Eyewear
Protective Glove Biological Monitoring Risk Assessment Safety
Hazardous Waste Product Health and Safety Toxicology Respiratory Protection
Computer Applications Emergency Response Planning Laboratory Equipment Non-Ionizing Radiation
N / A  
8. Services of interest
9. How did you learn about this conference? Others:
10. How do you allocate the majority of your professional time?
 
   
 
 

Conference Secretariat
c/o MCI Malaysia Management Sdn Bhd
Suite 12.9, Level 12, Wisma UOA 2, 21 Jalan Pinang, 50450 Kuala Lumpur, MALAYSIA
Tel: +603 2162 0566 Fax: +603 2161 6560
Email: aiha.reghot2014@mci-group.com