REGISTRATION FORM

USD 954.00

USD 1007.00

RM 265.00

RM 318.00

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LPO

VISA

Master Card

After 30 April 2017

I have authorized the 12th Liver Update Meeting Secretariat to debit the total amount of USD/RM* _______ from my credit card for the settlement of the above mentioned fees.

12th Liver Update Meeting Secretariat

Malaysia Liver Foundation

No.26 Block C, Jalan PJU 1A/3,

Taipan Damansara 2, Ara Damansara

47301 Petaling Jaya, Selangor

prema@loveyourliver.org.my

secretariat@loveyourliver.org.my

amirah@loveyourliver.org.my

Fee Information (inclusive GST)

Before 30 April 2017

RM 954.00

RM 1007.00

RM 742.00

RM 795.00

Mods of Payment

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