DELEGATE INFORMATION
TITLE: FIRST NAME: LAST NAME:
ID/PASSPORT NO: NATIONALITY:
ORGANIZATION NAME: ORGANIZATION ADDRESS:
CITY: STATE: POSTAL CODE:
EMAIL: MOBILE NUMBER:
EMERGENCY CONTACT NUMBER/NAME:
DIETARY PLEASE TICK () No Dietary Requirement Vegetarian Vegan Peanut Allergy
* All foods served in the hotel are halal
Please tick where applicable:
A. MAIN CONGRESS REGISTRATION 7th – 8th
October 2016 – Berjaya Times Square Hotel, Kuala Lumpur.
CATEGORY SUPER EARLY BIRD
(25 Dec 2015 – 15 Feb 2016) EARLY BIRD (16 Feb – 31 Mar 2016) NORMAL REGISTRATION (1 Apr – 31 Aug 2016) LATE REGISTRATION (1 Sept – 30 Sept 2016)
Local MPA Member MYR 1,050 MYR 1,150 MYR 1,250 MYR 1,350
Local Non– MPA Member MYR 1,750 MYR 1,950 MYR 2,150 MYR 2,350
Local Student MYR 950 MYR 1,000 MYR 1,050 MYR 1,100
Local Retiree MYR 950 MYR 1,000 MYR 1,050 MYR 1,100
Local Day Registration MYR 900 MYR 980 MYR 1,080 MYR 1,200
Local Accompany Person MYR 850 MYR 950 MYR 1,050 MYR 1,250
MPA Member YES NO MPA Membership Number: ______________________ IMPORTANT NOTES:
I. All fees are inclusive of 6% GST.
II. All registration categories except “Accompany Person” category have the access to all plenary and concurrent sessions.
III. All registration categories are entitled to receive the congress material, access to exhibition & poster area, refreshment breaks and lunches. IV. Only Accompany Person category can enjoy free accompany tour during the congress day. (Tour Name To Be Advise)
V. Fees for gala dinner, accommodation, flights, and airport transfers are NOT included in the congress registration fees.
VI. Student rate only applies to all 'Undergraduate' students in any universities. A copy of Student ID card or Letter from University is required for verification.
VII. Post Graduate student are required to register as normal delegate.
VIII. Retiree rate applies to all Malaysian retirees only. A copy of Retirement Card is required for verification. IX. Payment for Malaysian Delegate should be made in MYR (Malaysian Ringgit) only.
X. 10% discount will be accorded to Group Registration with a minimum of 10 delegates. Kindly request the Group Registration Form from the Secretariat via email at [email protected]. *Terms & Conditions Apply
If Other, Please Specify (Dietary)
DIETARY REQUIRMENTS
SECTION 1 :: REGISTRATION FEE
B. PRE-CONGRESS WORKSHOP 5th – 6th October 2016, 9AM - 5PM
WORKSHOPS REGISTRATION FEE
Motor Control Training for Low Back and Pelvic Pain by Paul Hodges MYR 1,600 Articular Manual Therapy for Mechanical Neck Pain Disorders by Vaidas Stalioraitis MYR 1,500 Treatment of Cerebral Palsy with Bobath Techniques by Hong Jung Sun MYR 1,000 McConnell Approach to the Problem Knee by Alfio Albasini MRY 1,500
C. POST-CONGRESS WORKSHOP 9th – 10th October 2016, 9AM - 5PM
WORKSHOPS REGISTRATION FEE
McConnell Approach to the Problem Shoulder by Alfio Albasini MYR 1,500 Note: Venue to be advised.
IMPORTANT NOTES:
I. Fees are inclusive of 6% GST.
II. Registration fee is inclusive of refreshment breaks and lunches.
Please tick where applicable:
You are cordially invited to the MPA partly subsidised Gala Dinner with minimal entrance ticket as append below:
ITEM RATE/PAX PLEASE
TICK ()
NUMBER OF PAX
Gala Dinner (Delegate) MYR 200 N/A
Registered Accompany Person MYR 200 N/A Additional Ticket(s) MYR 300
Total MYR
Please tick where applicable:
Flight details are required for airport transfers. These details must be received not later than 1st September 2016. (Kindly email us your date/time of arrival/departure and flight number to [email protected] if you have not provided the details upon submitting registration form).
* KLIA = Kuala Lumpur International Airport * KLIA2 = Kuala Lumpur International Airport 2
AIRPORT TRANSFER AMENDMENTS AND CANCELLATION POLICY: I. Fees are inclusive of 6% GST.
II. All transfers are on private basis.
III. All amendments must be made in writing fourteen (14) days prior to the transfer booked date. IV. No refund for cancellation made after 15th September 2016 for transfers booked and paid.
V. No refund will be granted for no-show reservations.
VI. Pick up for departure airport transfer is 4 hours prior to the flight ETD. Passenger(s) is(are) advised to be punctual to avoid disappointment. VII. One CAR is for a maximum of two passengers only.
VIII. One VAN is for a maximum of four passengers only. AIRPORT
TRANSFER
By CAR
Maximum 2 passengers only
By VAN
Maximum 4 passengers only NUMBER OF PAX One–Way
Transfer
One–Way Transfer With Midnight Surcharge
One–Way Transfer
One–Way Transfer With Midnight Surcharge Airport to City Hotel MYR 170 MYR 255 MYR 250 MYR 375
City Hotel to Airport MYR 170 MYR 255 MYR 250 MYR 375
TOTAL MYR MYR MYR MYR
SECTION 3 :: AIRPORT TRANSFER
SECTION 2 :: GALA DINNER & OPENING CEREMONY
Flight Details:
ARRIVAL DETAILS
Pick – Up Point KLIA KLIA2 Drop – Off Point
Arrival Date Arrival Time (HH:MM) Carrier Name Flight No. Flight Details: DEPARTURE DETAILS Pick – Up Point
Drop – Off Point KLIA KLIA2 Departure Date
Departure Time (HH:MM) Carrier Name
Flight No.
IMPORTANT NOTES:
I. Fees are inclusive of 6% GST.
IMPORTANT NOTES:
Midnight Surcharge applies for the following:
I. Arrivals: Flight ETA between 23:00hrs and 07:00hrs. II. Departures: Flight ETD between 01:00hrs and 09:00hrs
Please tick where applicable:
Check– In Date : (DD/MM/YYYY) Check–Out Date : (DD/MM/YYYY)
Name of 2ndGuest : ____________________________________ (if applicable)
Term & Conditions:
I. Fees are inclusive of 6% GST.
II. Room rates are nett price. All roomsare subject to availability and individual hotel policy applies. III. Payment for accommodation must only be made via Credit Card.
IV. For inquiries, please send e-mail to us at [email protected].
Please tick where applicable: A. CONGRESS SPONSORED TOURS
TOUR DATE TIME (hrs) PLEASE
TICK ()
A. Kuala Lumpur City Orientation Tour 9 Oct 2016 0830 – 1230 B. Kuala Lumpur Countryside Tour 9 Oct 2016 0830 – 1230 C. Cheras Rehabilitation Hospital 9 Oct 2016 0830 – 1230 Terms & Conditions:
I. The above tours are sponsored by ACPT 2016.
II. Seats are limited. Kindly confirm your attendance by 31st August 2016 in order to confirm your seat. Failure to do so, your seat will be open to other delegates.
III. Pick-up & drop-off points will be at the Berjaya Times Square Hotel, Kuala Lumpur. B. DAILY TOURS
TOUR TIME (hrs) PRICE
PER PAX
PRICE FOR
TWO (2) PAX REMARKS Total
A. MUD, STORY OF KUALA
LUMPUR 1400 – 1800 MYR 335 MYR 395
Inclusive of MUD Show Entrance Ticket MYR B. PUTRAJAYA SIGHTSEEING 0830 – 1230 MYR 480 MYR 535 Inclusive of Putrajaya
Cruise MYR
C. KUALA LUMPUR BY NIGHT 1700 – 2200 MYR 385 MYR 495 Inclusive of Dinner and Cultural Performance MYR D. MALACCA DAY TRIP 0900 – 1700 MYR 690 MYR 770 Inclusive of Lunch MYR E. KUALA SELANGOR FIREFLIES
TOUR 1600 – 2200 MYR 755 MYR 825
Inclusive Seafood Dinner and Entrance Ticket MYR F. SUNWAY LAGOON THEME
PARK 0930 – 1530 MYR 730 MYR 910
Inclusive of All Park
Entrance MYR G. A DAY IN RAINFOREST 0900 – 1500 MYR 295 Minimum of 4pax MYR
GRAND TOTAL MYR
Date of Tour 4th Oct 2016 5th Oct 2016
Name of 2ndPax: ______________________________ (if applicable) Name of 3rd Pax: ______________________________ (if applicable) Name of 4th Pax: ______________________________ (if applicable)
HOTEL NAME HOTEL
RANKING TYPE OF ROOM RATES / NIGHT BREAKFAST PLEASE TICK () NUMBER OF
ROOM (S) TOTAL (MYR) Berjaya Times Square
Hotel Kuala Lumpur 5-Stars
Studio Single MYR 430.00 MYR
Studio Double MYR 465.00 MYR
Furama Hotel Kuala
Lumpur 4-Stars Superior MYR 270.00 MYR
Royale Bintang Hotel
Kuala Lumpur 4-Stars
Superior MYR 315.00 MYR
Deluxe MYR 325.00 MYR
Ansa Kuala Lumpur 4-Stars Deluxe MYR 295.00
Complimentary Starbucks
Voucher
MYR
GRAND TOTAL MYR
SECTION 5 :: SPONSORED & DAILY TOURS
SECTION 4 :: ACCOMMODATION
Term & Conditions:
I. Fees are inclusive of 6% GST.
II. All tours are on private basis based on maximum of 2pax, except for A Day in Rainforest which is based on minimum of 4pax. III. Kindly visit our website at www.acpt2016kul.org for more information about the tours.
IV. Pick-up & drop-off points will be at the Berjaya Times Square Hotel, Kuala Lumpur. V. All amendments must be made in writing fourteen (14) days prior to the tour booked. VI. No refund for cancellation made after 15th September 2016 for tours booked.
VII. No refund will be granted for no-show reservations. All the passengers are advice to be punctual.
PAYMENT DETAILS TOTAL (MYR)
Section 1: Registration MYR
Section 2: Gala Dinner MYR
Section 3: Airport Transfer MYR
Section 4: Accommodation MYR
Section 5: Sponsored & Daily Tours MYR
GRAND TOTAL MYR
Please tick ( ) where applicable:
1. CREDIT CARD ( ) – 3% Admin Fees Applicable
I hereby authorize “ACPT 2016 – AOSCE” to charge my credit card for the total amount of MYR ____________________ Cardholder Name:_______________________________________________________
Card Number: Secure Code (CVV/CVC):
Expiry Date:_____/_____ (MM/YY) Card Type: MasterCard Visa Signature: __________________________ * Note: Please attach a scanned copy of your credit card upon your submission of this form for verification purpose. 2. TELEGRAPHIC / BANK TRANSFER ( )
Payment via transfer must be made without charges to beneficiary and payable to: Account Name : ACPT 2016 – AOSCE
Account Number : 3121–9453–5566
Bank Name : Standard Chartered Bank Malaysia Berhad
Bank Address : KL Main Branch, Ground Floor, No. 36 Jalan Sultan Ismail, 50250 Kuala Lumpur, Malaysia Swift Code : SCBLM-YK-XXXX
3. LOCAL PURCHASE ORDER ( )
LO Number: Amount: MYR
I. Registration Entitlement
1. All fees are inclusive of 6% GST.
2. All registered participants (except “Accompany Person” category) may enjoy the all access to the congress sessions
3. All registered participants are entitled for opening ceremony, coffee/tea breaks, lunches, access to the exhibition and poster area, delegate bag and other related congress materials.
4. Only Accompany Person category can enjoy free accompany tour during the congress day. (Tour Name To Be Advise)
5. Student rate only applies to all 'Undergraduate' students in any universities. A copy of Student ID card or Letter from University should be sent to the ACPT 2016 Secretariat via e-mail at [email protected] or fax to +603 4257 1133.
6. Post Graduate student are required to register as normal delegate.
7. Fees for gala dinner, accommodation, flights, and airport transfers are NOT included in the congress registration fees. II. Registration Process and Payment
1. Participants may register via online registration at www.acpt2016kul.org. Alternatively, they may complete the registration form and send it to the ACPT Secretariat via e-mail at [email protected] or fax to +603 4257 1133.
2. Online registration is only open until 30th September 2016 (GMT +8hrs). After 30th September 2016, kindly register onsite at the congress venue where registration counter will be open on 6 Oct 2016 from 2pm – 5.30pm.
3. Full payment of registration fee must be received by 31st August 2016 (accept payment via Local Order).
4. For payment made via Local Order (LO), the original copy of LO must be received by 31st August 2016. Please mail the original copy of the LO (Local Order) to the ACPT 2016 Secretariat for verification purpose.
5. Confirmation letter of registration will be sent via email upon full payment of the registration fee received. Please bring along the confirmation letter and present it at the registration counter during the congress.
6. Payment of registration fees can be made via:
a. Credit Card (Visa & MasterCard only. 3% admin fee is required.) b. Telegraphic Transfer
c. Local Order (Applicable to Malaysian Government Agencies only)
SECTION 8 :: TERMS AND CONDITIONS OF REGISTRATION
SECTION 6 :: SUMMARY
SECTION 7 :: PAYMENT METHOD
7. For payments made by Credit Card, the amount reflected in the Credit Card statement will be in the currency of the cardholder's country of origin. If an invoice is requested, the amount paid will be reflected in MYR only.
8. The Organiser reserves the right, and will inform Participants on any alteration to any of the arrangements for the ACPT 2016 including the cancellation of the event should unforeseen circumstances require such action.
9. In the special circumstances that the entire event has to be cancelled, the Organiser will refund the registration fee to the Participants. However, the Organiser will not be liable for other associated costs, e.g. accommodation and travelling expenses, and any inconveniences incurred to the Participants due to the cancellation. Therefore, Participants are advised to arrange for their own travel insurance.
III. Registration Transfer
All registrations are transferrable on or before 30th September 2016. Transfer requests must be made by e-mail to the ACPT 2016 Secretariat at
[email protected] or fax to +603 4257 1133. The new Participant should complete the registration form and revert to us by 30th
September 2016. Transfer of registration will not be allowed on or after 1st October 2016. IV. Cancellation and Refund Policies
1. All cancellation of registration must be done in writing and submitted to the ACPT 2016 Secretariat via e-mail at [email protected] or fax to +603 4257 1133.
2. Any cancellation on or before 31st July 2016 will be entitled for 75% refund from the total Paid Registration Fee.
3. Any cancellation within 1st August 2016 until 31st August 2016 will be entitled for 50% refund from the total Paid Registration Fee.
4. Refund will be made after deducting other related fees and charges incurred in connection with such refunds, including costs of foreign exchange conversion, Credit Card cancellation and/or banking transaction.
5. Any cancellations on or after 1st September 2016 will not be refunded. 6. All refunds will be made in MYR at the prevailing foreign exchange rate.
7. Refund for cancellations will be made within three months after the congress. Any charges imposed by banks and Credit Card issuers will be borne by the Registrants.
VI. Liability
The Organiser reserves the right to make changes where deemed necessary, with or without prior notice to parties concerned. All disputes are subjected to the Malaysian Law. We kindly ask you to authorise us by your signature to use all registration data given in this form for computerised handling of the conference.
I hereby accept all terms of participation without reservation or restriction and we relinquish any claims against the Organiser. The Organiser reserves the right to cancel or postpone the Conference due to unforeseen circumstances.
Signature: Date:
(By signing and returning this form, you are accepting all the terms and conditions)
ENQUIRIES
For enquiries, please contact us at:
Please return this form to: ACPT 2016 Congress Secretariat c/o AOS Conventions & Events Sdn. Bhd. (Member of AOS Tourism & Hospitality Group) Address: 2nd Floor No. 39 & 40, Jalan Mamanda 9, Ampang Point, 68000 Selangor, Malaysia.
Office Number: +603 4252 9100 Fax Number: +603 4257 1133 Email: [email protected] Website: www.acpt2016kul.org
Hosted By: Supported By: Official Airlines Partner:
