MIOCE 2023 Registration Form

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BANK TRANSFERS
PERSATUAN PENGAMAL ORTODONTIK MALAYSIA

CIMB 8602435440
Swift CODE: CTBBMYKL
Bank Address
CIMB Bank- The Curve
Ground Floor, The Curve, Lot G62, No.6 Jalan PJU 7/3, Mutiara Damansara, 47800 Petaling Jaya, Selangor, Malaysia

Please note for Payment Reference
MIOCE 1pax/2pax/3pax. OR MOPA 1pax
or MOPA/MIOCE 1pax

contact Dr.Fajriah +60 19-655 2779 or Dr.Putra +60129171140 for guidance and support

Not yet being our member? Dont miss our lifetime membership promotion!
JUST MYR 100 for registration and MYR 100 for LIFETIME MEMBERSHIP!

Total MYR200 to be a member and get many/various benefit such as special rate for events held by MOPA and more to come!

Please note for Payment Reference
MIOCE 1pax/2pax/3pax.
MOPA/MIOCE 1pax

thank you

Email *

Full Name With Salutation *

IC/Passport No. *

MDC No. (For Malaysian Dentist Only)

Clinic/Working Name & Address
*

Phone Number
*

Are you a MOPA member?
*

YES

Not Sure

How would you like to pay?
*

Bank Local Malaysia Transfer

Other:

all information above are (Please check and tick True)
*

True

Required

Submit

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