Organizers:
Supporting
Co-Organizers:
Agencies:
29th World Congress of the International Association for Suicide Prevention (IASP)
21th Malaysian Conference of Psychological Medicine (MCPM)
July 18-22, 2017, Kuching, Sarawak
Preventing Suicide: A Global Commitment, from Communities to Continents
Mental Illness: Early Intervention Facilitates Recovery (MCPM)
REGISTRATION FORM
PARTICULARS
Please write in BLOCK LETTERS:
* Full Name:
Preferred Name on tag:
* Designation / Position:
* Affiliation:
* Address:
City:
State:
Country:
Postal Code:
* Tel:
* Fax:
* Mobile No:
1
* Email:
Participating in any oral/ poster presentations?
YES
NO
** Delegate will have to register to be eligible for any presentations at the conference
Special diet preference
NO
YES
Gluten-free
Vegetarian
Vegan
REGISTRATION FEE
Please tick where appropriate
* Please note: ALL FEES ARE INCLUSIVE OF 6% GOODS AND SERVICES TAX (GST)
PRECONFERENCE WORKSHOPS
Pre-Conference workshops: USD 150 for international delegates and RM 300 for Malaysian delegates. Delegates are allowed to register for only one workshop.
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I wish to attend the workshop (Please tick one only):
Workshop 1
Workshop 2
Workshop 3
Workshop 4
Workshop 5
Workshop 6
Workshop 7
Mindfulness
Based Cognitive
Therapy and
Cognitive
Flexibility
Suicide in Older
Adults
Cognitive
Behavioural
Therapy for
suicidal persons
Psychological
autopsy
Gatekeeper
training: The bridge
between suicide
and life
The solution
focused
approach to
suicide
prevention
Supervision in
psychodynamic
psychotherapy
REGISTRATION
LOCAL DELEGATES:
Category of
Delegates
Malaysian Delegates
Kindly indicate
where applicable
Workshop
RM300
Early Bird
Late/ Onsite Registration
(1st December, 2016 to 31st May,
2017)
(Late:1st June to 1st July, 2017)
RM1300
RM 1400
Workshop
Number:
TOTAL
3
For International delegates the fees are based following the World Bank economic zones:
INTERNATIONAL DELEGATES (USD): Conference fee based on World Bank economic zones
International Delegates
Please tick where appropriate
IASP Members
Workshop
Non-members
Early Bird
(1st December,
2016 to 31st May,
2017)
Late & Onsite
Registration
(Late: 1st June to 1st
July, 2017)
Early Bird
(1st December,
2016 to 31st May,
2017)
Late & Onsite
Registration
(Late:1st June to 1st
July, 2017)
610
640
640
690
Zone 2
Upper-middle-income (USD)
510
530
530
585
Zone 3)
400
425
425
480
Zone 4
Low-income (USD)
325
350
350
375
150 (USD)
Zone 1
High Income (USD)
Workshop Number:
4
Local and international students/
non-professional volunteers /
bereaved persons
320
375
TOTAL:
* Please note: ALL FEES ARE INCLUSIVE OF 6% GOODS AND SERVICES TAX (GST)
A small number of bursaries covering Registration fees and Accommodation will be available, funds permitting, for selected participants/students who are presenting papers. The
decision of the Organizing Committee regarding eligibility for bursaries shall be final.
ACCOMPANYING PERSONS:
ACCOMPANYING PERSON
Please tick where appropriate
Per day
Zone 1
High Income (USD)
USD 80
Zone 2
Upper-middle-income (USD)
USD 70
Zone 3
Lower-middle-income (USD)
USD 60
Number of days
Total
5
Zone 4
Low-income (USD)
USD 50
* Please note: ALL FEES ARE INCLUSIVE OF 6% GOODS AND SERVICES TAX (GST)
Members of the public are allowed Day Registration:
DAILY REGISTRATION
DAY REGISTRATION
Please tick where
appropriate
Per day Wednesday- Friday
Malaysian
Number of days
Saturday, 22 July (half-day)
RM425
RM215
Zone 1
High Income (USD)
USD 215
USD 110
Zone 2
USD 190
USD 95
Total
International Delegates (USD):
6
Upper-middle-income
(USD)
Zone 3
Lower-middle-income
(USD)
USD 160
USD 80
Zone 4
Low-income (USD)
USD 110
USD 55
* Please note: ALL FEES ARE INCLUSIVE OF 6% GOODS AND SERVICES TAX (GST)
HOTEL BOOKINGS
Hotel booking: kindly liaise with the hotel using the forms provided on the website.
MODE OF PAYMENT
Payment for registration fees can be made by either method below:
1) PayPal: Payable to “Mobition Sdn Bhd”
2) Local Purchase Order: Addressed to “Malaysian Psychiatric Association”
MPA Bank Account Details
Account Name:
Account Number:
Malaysian Psychiatric Association
8008023397
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Bank:
Address:
Tel. No. of Bank:
Swift Code:
CIMB Bank
No 72a Jalan Universiti, A-1-G, Block A, Jaya One, 46200 Petaling Jaya, Selangor, Malaysia
+603-7964 4600
CIBBMYKL
Without proof of nationalities or working status invoice, participants will be considered as being under the high income category.
Please email the registration form with the necessary documents to: [email protected]
REFUND POLICY:
In the event of any cancellation of registration, 15% will be deducted from the registration fee for the processing purposes if it is made by 31st May, 2017. If
the application of the cancellation is only received by the secretariat after the stated date, only 50% of the paid registration fee will be returned. There will be
no refund if the request is made after 17th June, 2017. Any request for cancellation of registration must be sent to the secretariat via email, ASAP.
IMPORTANT DATES:
Deadline of abstract for oral (free paper) and poster submission: 15th February, 2017
Notification of decision on abstracts submission: 17th May, 2017
Abstracts submission send to: [email protected]
For further information kindly contact the Congress Secretariat: [email protected]
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