REGISTRATION FORM

BOARD OF ENGINEERS MALAYSIA

BEM ROADSHOW 2017
(SESSION 1 – AM)

A. PERSONAL PARTICULARS

1. Name : ………………………………………………………………………………………...

2. Registration No. : …………………………………………..

3. Employer : …………………………………………………………………………………….......

4. Address : …………………………………………………………………………………….......

…………………………………………………………………………………….......

5. Contact No. : Telephone: ……………………………….

: Mobile: ……………………………………

: Fax: ……………………………………….

: Email: …………………………………….

B. VENUE
Kuching, Sarawak DoubleTree by Hilton Hotel,Johor Bahru
(4th July 2017) (4th October 2017)
G HOTEL PENANG Grand Ballroom, Level 1 Magellan
18th July 2017 - Tuesday Sutera Resort Kota Kinabalu, Sabah
Grand Ballroom, Level 2 (2nd November 2017)

C. PAYMENT
Registration fee amount RM 50.00 payable to “LEMBAGA JURUTERA MALAYSIA”
Method of payment as follows:
* (www.maybank2U.com.my) Dated : …………………………….
* (www.cimbclicks.com.my) Dated : …………………………….
* (www.rhbbank.com.my) Dated : ……………………………..
* Local Order
* Cheque No. …………………….
* Money Order / Postal Order No. ………………………………..

D. SUBMISSION
Completed form to be faxed to 03-2692 5017 or email to muzilah@bem.org.my with payment/
transaction slip to:
BOARD OF ENGINEERS MALAYSIA
11th Floor, Block F, Ibu Pejabat JKR
Jalan Sultan Salahuddin, 50580 Kuala Lumpur
Tel: 03-26912090 ext. 123 / 124 / 157

Note: * Please tick (√) whichever applicable. No refund for any cancellation. A substitute attendee is allowed