Registration

AZ ULTOMIRIS Launch

Salutation

Full Name as per NRIC

Email Address

Contact Number

NRIC No.

MMC No.

Place of Practice

Specialty

Specialty: Others

State

ARRIVAL | BKI-KUL
Airport Transfer Included

ARRIVAL | KCH-KUL
Airport Transfer Included

DEPARTURE | KUL-BKI
Airport Transfer Included

DEPARTURE | KUL-KCH
Airport Transfer Included

Others

ACCOMMODATION at PARKROYAL Collection KL
Check-in 27 June 2026 | Check-out 28 June 2026

Medical Representative Name

Medical Representative Email

Dietary Restriction

Dietary Restriction: Others

Do you required Lunch

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