柔南中小企业公会 SME Johor Selatan / SME South Johor (SMEJS)

REGISTRATION FORM

ONE-DAY SEMINAR ON FOOD REGULATIONS (Nutritional Labelling & Claims)
And MALAYSIA STANDARD ms 1500:2004 ON HALAL FOOD

8TH SEPTEMBER 2005

EDEN GARDEN HOTEL JOHOR BAHRU

Hon Secretary, IKM Southern Branch
C/o Jabatan Kimia Johor, Jalan Abdul Samad
80100 Johor Bahru, Johor.
Tel No: 07-222 6569 Fax No: 07-223 8366
Email : [email protected]

Please register me/the following for the above training course:


1. Name : ………………………………………………...…..(Member / Non-Member)*
Designation : ………………………………………………

2. Name : ………………………………………………...….(Member / Non-Member)*
Designation : ………………………………………………

3. Name : ………………………………………………...….(Member / Non- Member)*
Designation :…………………………………………………

Organisation :……………………………………………………………………………………………….

Mailing Address: ……………………………………………………………………………………………...

……………………………………………………………………………………………................................

Tel: …………………………. Fax: ……………………… . E-mail: …………….....……………………….

[ ] Please book on our behalf the accommodation at Eden Garden Hotel, Johor Bahru for ………….night(s) stay in Deluxe Single / Deluxe Double* room.

Check-in date :……………………………. Check-out date :…………………………………………

[ ] Total Registration Fees RM ………………………………….
Hotel Deposit (One-night deposit for hotel confirmation) RM ………………………………….
Total Amount RM ………………………………….

[ ] A cheque / government local order no ……………………….. for the amount RM ……………………
made payable to “Institut Kimia Malaysia Cawangan Selatan” is enclosed.


Signature:……………………………………..…………………… Date:………………………………….

Name:………………………………………………………………