REGISTRATION FORM

SOUTHERN REGION
QUALITY ENVIRONMENT (5S) CONVENTION 2009
HOTEL RENAISSANCE, MELAKA
17 DECEMBER 2008 (THURSDAY)
Please register the following person (s) for the above programme:
No. Name Designation

1.

2.

3.

4.

5.

Organisation :_______________________________________________

Mailing Address :__________________________________________________________

________________________________________________________________________

Tel. :_________________________ Fax :______________________

Name of Contact Officer :__________________________________

Designation :____________________________________________

e-mail : ____________________________

Payment will be made in Cheque / Cash / LO for the amount of RM ____________ during the registration
of the event.

Contact person for Billing Purposes : __________________________________________

Address : ________________________________________________________________

________________________________________________________________________

Tel. : _________________________ Fax : ________________________

Organisation Size: Multinational / Large / SMEs / Government

Authorised Signature:________________ Company Stamp:

Date:________________

Registration and payment should be made Five (5) days before the commencement of the programme. Reservation can be
made by phone, mail, fax or e-mail, but will be confirmed upon receive of the registration form and payment. A full fee is
chargeable if no written notice of cancellation is received by MPC five (5) days before the programme commences or if the
participant fails to report for the programme. Cancellation with less than five (5) days notice will not be accepted. However,
substitute participant (s) is/are always welcome. MPC reserves the right to change the venue or the facilitators or the
contents of the programme or reschedule or cancel the programme due to unforeseen circumstances and will notify registered
participants accordingly. For further enquiries, please contact En. Mazuan Salih at Tel. : 07-2377422 or Fax : 07-2380798 or
e-mail : mazuan@mpc.gov.my