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 : sschong@kimia.gov.my

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:¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­