MAAFIM Nutriomics

Registration Form

Salutations *

Full Name *

As in NRIC/Passport

Email address *

IC / Passport No: *

MMC No.

*Only for Malaysian Participants to collect CPD Points. Failure to provide MMC No. will result CPD points not submitted to MMC

Mobile Number *

Please add + with your Country Code e.g. +60123456789

Street address *

City *

Postal code *

State *

Payment Slip Upload *

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Please transfer payment of RM400 to Maybank MAAFIM 512884225583