REGISTRATION FORM_Spirometry 3

REGISTRATION FORM

MTS SPIROMETRY PHASE 3
MTS SPIROMETRY CERTIFICATION PROGRAMME

PHASE 3 COURSE

Date : 2nd - 3rd August 2025

Venue : Postgraduate Centre, Level 3, Hospital Tunku Azizah, Kuala Lumpur

For any enquiries please contact:
Email: mts.spirometry@gmail.com
Tel: 03-2856 4053
Fax: 03-2856 4195
Name*

PrefixFirst NameLast Name
Phone Number*

Area CodePhone Number
Personal Email*
example@example.com
Institution*
Year passed Spirometry Phase 1 *

MonthDayYear
Date
Are you MTS Member?*

YesNo

Registration	Early Bird Before 30.6.2025	Late Registration 30.6.2025 and after
MTS Member	RM 500.00	RM 600.00
Non-MTS Member	RM 650.00	RM 750.00
Non-Malaysian	USD 300.00	USD 400.00

On-site registration will not be accepted! Places are limited.
No refund for cancellation after 30th June 2025.
Government Local Purchase Orders (LPO) are not accepted.

All payments by cheque should be issued in favor of "Malaysian Thoracic Society".

Payments can be made via telegraphic transfer to the following account:

Account Name : Malaysian Thoracic Society
Account Number : 873-1-0420229-5
Name of Bank : Standard Chartered Bank Berhad
Address of Bank : Publika Branch Solaris Dutamas Jalan Dutamas 1,
50480 Kuala Lumpur

Each registration per participants

Choose your registration*
Payment Method*

Online PaymentATM Deposit
Date of Payment*

DayMonthYear
Date
Payment Reference Number*
Please attach your proof of payment here*

Cancelof
Do you have any dietary restriction or allergies?*

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REGISTRATION FORM

MTS SPIROMETRY CERTIFICATION PROGRAMME

PHASE 3 COURSE