REGISTRATION FORM ONLINE
INTENSIVE COURSE IN ABDOMINAL RADIOLOGY 19th.-23rd. September 1999
1. Name:
2. Address
3. Institution and Department
4. Tel no:
5. E-mail:
6. Computer knowledge: Excellent (10-9) Very Good (8-7) Good (6-4) Fair (3-1) Nil(0) ExcellentVery GoodGoodFairNil
7. Internet usage: (please specify purpose: e-mail, radiology CME Homepage, general topics, ... )
Very Regular (>5x/week) Regular (3-4 x/week) Moderate (2x/week) Fair (few/month) Nil Very RegularRegularModerateFairNil
Cheque or Bank draft should be made payable to "Timbalan Bendahari USM" Enclosed cheque No: Bank:
8. Reservation for House Officer Hostel (only limited places available) NoYes Check-In date :
9. Reservation for Perdana Hotel (for special discount price as noted) NoYes Check-In date :
*Thank you for your registration. Have a Nice Day.