REGISTRATION FORM

To: MASHRAE c/o PrudEnergy Consulting Sdn Bhd E-1-3 Neo Damansara, Jalan PJU 8/1, Damansara Perdana, 47820 Petaling Jaya. Tel: Fax: E-mail: Contact Person: +60 12-286 1319 +60 3-7726 5512 mashrae.my@gmail.com Ms Jessie Chong

Date: Time: Venue:

27 December 2013 8.15am 12.15pm Dewan Kuliah 5 (DK5), Block L, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur.
Name Contact no.

Registration fees: Member of MASHRAE Member of IEM, ACEM, PAM, ASHRAE Non-member

RM 150.00 RM 180.00 RM 200.00

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Recommended Grade Fee(s) By RM

Enclosed here with is a crossed cheque No. _______________ for the sum of RM ____________ issued in favour of "Malaysian Chapter of ASHRAE". (Course fee must be sent with registration form in advance. Delegates may be refused admission if payment is not received prior to the event.) I/We understand that the fee is not refundable if I/We withdraw after my/our application is/are accepted by MASHRAE but substitution of participants will be allowed. If I/We fail to attend the course, I/We will settle the registration fee in full. Contact Person: .................. Designation: ...

Name of Organization: ....... Address: .... ... Tel: (O) .. (H/P) . (Fax) .. (E-mail) ....

.. Date

..... Signature