MICE360 :: Create New Delegate

Terms & Conditions:

Deadline for Early Bird Registration: 15th March 2024.
Voucher not redeemable for cash.
Voucher not redeemable for workshop.
Voucher and Lucky Draw does not apply to the following categories of delegates:
- i. Dental students attending the Conference
- ii. Delegates attending all Workshops
Voucher validity period are from 15th - 17 May 2024.
*RM50 Voucher for visitor is strictly for licensed/certified dental practitioners only.

Title *

Category *

First name *

Full Name (as per your MyKad / Passport)

Last name *

Username *

Usernames may include alphanumeric characters but not spaces. ( ), eg: johnwu

Email *

Password *

Use 6 or more characters with a mix of letters, numbers & symbols.

Confirm password *

Confirm password

Identity No. *

MyKad No. (Malaysians) / Passport No. (Non-Malaysians)

Contact No. *

Mobile No.

Company Name *

Institution / Clinic / Company Name

Department

MDC Number

For MDC (Applicable for Malaysians Only)

DCR Number

For DCR (Applicable for Singaporean Only)

STR Number

For STR (Applicable for Indonesian Only)

MAHSA Staff / Alumni ID No. / Student ID

For MAHSA Staffs / Alumni & Student Only

Dietary Requirement *

Student Remark

University name or Student signup code

Sector *

Address 1 *

Address 2

Postcode *

Country *

State *

City *

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