Mind Science Association Of Malaysia - Online Application


CLOSING DATE is 10 days before start of Workshop. Pre-registration is welcome.
Please contact MSM Leader for course dates and click on Mind Science Course for Workshop synopsis.

LIMITED PLACES ONLY – Book early to secure a place by filling in preliminary registration form below and click SUBMIT button to email it to hdenson98@yahoo.com or fax particulars to 03-62578910.

Yes, I am interested in attending the Mind Science Workshop.


1. Venue
KUALA LUMPUR
MELAKA
SEREMBAN
IPOH
PENANG
JOHOR BAHRU
KUANTAN
KOTA KINABALU
LONDON
VANCOUVER
PERTH

2. Preferred Date for Workshop:(dd/mm/yy)

3. Name:   

4. Gender:   Male. Female.
5. Age:   
6. New NRIC Number:   [700604-08-5454]
7. Tel:   
8. Mobile:   
9. Fax:   
10. E-mail:   
11.Address: