Appendix 2- Registration Form

Appendix II-Registration Form (Buyer)

BUYER REGISTRATION FORM FOR INDIVIDUAL BUSINESS MEETINGS ASSOCIATION OF PRIVATE HOSPITALS OF MALAYSIA (APHM 2017) Kuala Lumpur Convention Centre (KLCC), Kuala Lumpur, Malaysia 25-27 JULY 2017

Reply Fax / Email : +852-2804 2866 / [email protected] Deadline : 15 June 2017 Attention : Ms Ezzwanee Ahmad – MATRADE Hong Kong Company Details Name of Company: Address : Postcode : Countr y : Tel : E-mail: (with Country code) Website : Type of *Agent/Distributor/Importer/Manufacturer/Trader/Wholesaler/ Service business : Provider (* Delete which does not apply) Interpreter Do you need interpreter? Yes / No If YES please state the language :

Products/Services to Source from Malaysia (*Refer to Appendix III for Product Categories) No. Product Category * Details of Products / Services 1. 2. 3. 4. 5.

Representative(s) Details Name of Representative 1 (As in Passport) First Name Last Name Designation E-mail Passport No Nationality Expiry Date Mobile No. Name of Representative 2 (As in Passport) First Name Last Name Designation E-mail Passport No Nationality Expiry Date Mobile No.

Hotel Booking

Type of Room: Single ...... Double ...... Smoking...... Non-Smoking...... No. of Room (s)* ......

Flight Itinerary Representative 1 Arrival at Malaysian Airport (dd/mm/yy) Departure from Malaysian Airport (dd/mm/yy) Date : Date : Flight No: Flight No: Expected Time Arrival (24 Hrs Format): Expected Time Departure (24 Hrs Format):

Representative 2 Appendix II-Registration Form (Buyer)

Arrival at Malaysian Airport (dd/mm/yy) Departure from Malaysian Airport (dd/mm/yy) Date : Date : Flight No: Flight No: Expected Time Arrival (24 Hrs Format): Expected Time Departure (24 Hrs Format): Note:  Cost for only one (1) room per company will be borne by Ministry of Health Malaysia (4 days 3 nights).  Meeting slots with Malaysian exhibitors are based on first come first basis.