AI in Healthcare Conference Registration

Registration for Artificial Intelligence in Healthcare Conference 21-22 Aug 2019

Please provide all necessary information including each participant's hp and email to facilitate QR code for on-site registration.

Part 1: Company Info & Contact Person Info
Company Name (for invoicing and registration) *
Company Address
Line 1
Address Line 2
Line 2
Postcode
City/State
Country
Company Phone Number (eg 603 - 123455)

Area Code Phone Number
Is your company a member of APHM? *

Yes No Not sure
Contact Person's Name (HR or Person handling on behalf) *
Please put your own name if you are registering for yourself only
Contact Person's HP (follow this format 60121234567 country + number)
Contact Person's Email *
Please put your email if you are registering for yourself only

Part 2: Participant Info - Please provide complete info to receive QR code for on-site registrations
Please let us know how many pax that you are registering on behalf under same invoice/ same company (see comments below), so that we can extend group discount where applicable and for us to compile for invoicing purpose for all participants under one same company/registration/invoice. *
How many participants that you are registering under same group?
This is pax number ? *
Indicate if this is pax number 01; 02; 03..etc... that you are registering under same company...
Participant Full Name (include Dr/Dato etc) *
No need to indicate for Mr/Miss - only for official titles that goes with your name
Designation *
Email of participant to receive logistic info and QR code *
must be email of the participant and NOT the contact person/HR unless is the same person
Mobile HP of the participant to receive QR code and reminders (follow this format 60121234567 country + number) *
must be HP of the participant and NOT the contact person/HR
Please select which package *

2-day APHM Member (RM900) 2-day Non-Member (RM1,500) 2-Day Foreign Delegate (US$450)
If you have more than 3 delegates from same organisation, please select YES so that we can extend the group discount for you (Group Discount - 10% off for 3 o more delegates from the same organisation)

Yes No

Part 3: Payment Information
Payment Method - please select one *

Cheque Direct bank transfer Credit card via Paypal Telegraphic Transfer ePerolehan (via EventsMastery Asia Pacific Sdn Bhd)
IMPORTANT: Please read this

We will follow-up with you on the payment and will send the logistic information and QR code direct to each participant's mobile hp and email.

For companies registering more than 1 pax, please submit the form for each pax separately and indicate same company name & contact person name & email. For the 1st form that you fill, complete all the company and contact person info plus full details of pax No.1.

From 2nd pax onwards, you do not need to retype all the company info, only input the company name/contact person name & email and then proceed to complete all the info of the 2nd pax and indicate the pax number under - this is pax number ---?

Eg this is pax number 1, pax number 2....etc

Please email info@aphmevents.com for any clarification or information.
Any other comments or feedback for us to process this registration
Do you give consent for APHM to provide the participant's contact info to the participating Exhibitors of APHM. If you are registering on behalf, please note that your reply represents the pax. *

Yes No
By signing on this form and submitting this form online, you are agreeable to all the terms for this registration as indicated on the website https://aphmevents.com/payment/ *

Yes I agree
Please sign *

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Registration for Artificial Intelligence in Healthcare Conference 21-22 Aug 2019