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B O R A N G P E N D A F T A R A N NiCE 2013

B O R A N G P E N D A F T A R A N NiCE 2013. Sila isi maklumat di bawah untuk pendaftaran dan hantarkan borang ini melalui faks ke : 603-55225430/5467 atau email ke alamat nicemasmed@gmail.com. Nama (Tan Sri/ Puan Sri/ Dato ’/ Datin /Prof/ Dr /En/ Pn / Cik ) : Jawatan :

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B O R A N G P E N D A F T A R A N NiCE 2013

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  1. B O R A N G P E N D A F T A R A N NiCE 2013 Silaisimaklumat di bawahuntukpendaftaran dan hantarkanboranginimelaluifakske: 603-55225430/5467 atau email kealamatnicemasmed@gmail.com Nama (Tan Sri/Puan Sri/Dato’/Datin/Prof/Dr/En/Pn/Cik) : Jawatan : Institut / Organisasi : Alamat : Poskod : No. Telefon (Pej): No. Telefon (Bimbit): Alamat Email : YURAN PENYERTAAN – RM300.00 (Ringgit Malaysia TigaRatussahaja). (Tarikhtutup : 30/10/2013 –Rabu) Dibayaratasnama : BENDAHARI UiTM (PERWIRA AFFIN BANK) NomborAkaun - 105140003422 Silahantarcek /kirimanwang/buktipembayarankealamat MASMED seperti yang tertera di bawah. Kaedahpembayaran : Wang tunai (didepositkankeakaundiatas - silafaks slip deposit pembayaran) Kiriman wang : No. _________________ Cek/Deraf bank : No. ___________________ * Silahubungi MASMED untuk lain-lain kaedahpembayaran. Jikayuranpenyertaanandadibayar oleh institusi/organisasi, silanyatakannama dan alamatpenaja: No. Tel: ____________________________ No Faks: ___________________________ Malaysian Academy of SME & Entrepreneurship Development (MASMED) Blok 13, INTEKMA Resort & Convention Centre Seksyen 7, 40000 Shah Alam, Selangor DarulEhsan Tel: 03-5522 5429/5485/5486/5579/5580 Faks: 03-5522 5430/5467 http://masmed.uitm.edu.my email : nicemasmed@gmail.com

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