REGISTRATION FORM SYSTEMATIC REVIEW AND META-ANALYSIS WORKSHOP 26 TH to 28 TH October 2015 (3 DAYS) Selangor, Malaysia. REGISTRANT DETAILS

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1 REGISTRATION FORM SYSTEMATIC REVIEW AND META-ANALYSIS WORKSHOP 26 TH to 28 TH October 2015 (3 DAYS) Selangor, Malaysia. REGISTRANT DETAILS Salutation Full Name Institution/Company Department Contact Address Contact number Dietary Requirements Halal ( ) Vegetarian ( ) Others (please specify): REGISTRATION FEE Full Fee : RM 3,000 Group Fee : RM 2,600 Student Fee : RM 1,800 The fees include course materials, refreshments and lunches for the three days. Confirmation of participation in the workshop will be given upon receipt of full payment, which is to be made no later than 12 th October CANCELLATION All requests for cancellation must be made in writing to the organiser. The policy for refund of fees paid is as follows: (a) Full refund will be made for request made at least two (2) weeks before the start of the workshop; (b) A 50% refund will be made for request made at least one week before the start of the workshop; and (c) No refund for cancellation less than 1 week or no show. Substitutions of participants are welcome. SRS HEALTHCARE RESEARCH CONSULTANCY SDN BHD ( X) 1

2 ORGANISER S RIGHT TO CANCEL OR RESCHEDULE SRS Healthcare Research Consultancy Sdn. Bhd. (SRS) reserves the right to change the dates or speaker(s) where necessary, without prior notice. SRS further reserves the right to cancel the course without liability other than the refund of fees paid. PAYMENT OPTIONS (please mark the box indicating your choice) I/We enclose Cheque / Bank Draft No. for amount of RM (non-refundable) and made payable to SRS Healthcare Research Consultancy Sdn Bhd. [Please indicate registrant and company or institution s name on the reverse of the cheque]. Direct Bank-in to Hong Leong Bank Account number: Account name: SRS Healthcare Research Consultancy Sdn Bhd SWIFT Code (for overseas transactions): HLBBMYKL Please or fax ( ) the bank-in slip or EFT payment advice to SUBMISSION OF FORMS & PAYMENT SLIPS By post: Completed registration forms and cheques can be mailed to: Ms HE Yoong, c/o Hey Management C-6-12 Streetmall.One South. Jalan OS, Taman Serdang Perdana,Seksyen Seri Kembangan, Selangor, Malaysia Tel: Fax: By Scanned copies of completed registration forms and bank-in slips/ EFT payment advice can be ed to SRS HEALTHCARE RESEARCH CONSULTANCY SDN BHD ( X) 2

3 CONSENT By registering, you are giving SRS consent to collect, use and disclose your personal information according to the personal data policy stated in this document. We would like to receive information on future training events organized by SRS via or fax. If you do not agree to being contacted in this way, please tick X in the box. Declaration Statement Participant Contact Person SRS I hereby consent to the processing of my personal data for the purposes described in the Notice above. Signature: Name: Date: Signature: Name: Date: Issued by: SRS Training Division. For further information, please SRS Healthcare Research Consultancy Sdn. Bhd ( X) C-6-12 Streetmall.One South. Jalan OS, Taman Serdang Perdana,Seksyen 6, Seri Kembangan, Selangor, Malaysia. Tel: or Fax : Website: SRS HEALTHCARE RESEARCH CONSULTANCY SDN BHD ( X) 3

4 Personal Data Notice The SRS Healthcare Research Consultancy Sdn Bhd ( SRS, we or us or our ) is required to comply with the Personal Data Protection Act 2010 (the Act ). This regulates the processing of personal data in commercial transactions. For the purpose of this Personal Data Notice, the terms personal data and processing shall have the meaning as defined in the Act. This Personal Data Notice applies to any person whose personal data is processed by SRS or on behalf of SRS. 1. This Personal Data Notice informs you how your personal data is being processed by SRS. 2. The personal data processed by us may include your name, designation, company s name, contact details, address and any other personal data required for the purposes set out in paragraph 3 below. 3. SRS may use your personal data for the following purposes (collectively referred to as the Purposes ):(a) to process your registration form for training events (including conferences) organised by SRS and collaborative partner(s) and for administrative purposes such as attendance list, issue of invoice, official receipt and certificate of attendance;(b) to communicate with you on the confirmation of the training events and matters in connection to the SRS training events/conference; (c) to notify you of any changes to our training events which may affect you;(d) to mail the official receipt and certificate of attendance;(e) to respond to your enquiries or feedback; and (f) such other administrative purposes which relate to the above. 4. Your personal data is collected from various sources, including information you have provided us, information from third parties and information in the public domain. 5. You may access and request for correction of your personal data. Please contact us as follows if you have any enquiries or complaints in respect of your personal data: Designated Contact: Mailing address: Manager, SRS Training Division. SRS Healthcare Research Consultancy Sdn. Bhd. C-6-12 Streetmall, One South, Jalan OS, Taman Serdang Perdana, Seksyen Seri Kembangan, Selangor, Malaysia Fax No: Telephone No: solutions.cn SRS HEALTHCARE RESEARCH CONSULTANCY SDN BHD ( X) 4

5 In accordance with the Act: (a) We may charge a fee up to RM10 (for personal data) and RM30 (for sensitive personal data) for processing your request for access to your personal data; and (b) We may refuse to comply with your request for access to, or correction of, your personal data. 6. Your personal data may be disclosed:(i) to our vendor (in terms of address) for the purpose of blasts on behalf of SRS - applicable to SRS members, students and affiliates only; (ii) when authorised by law or by the order of a Court. 7. SRS shall retain your personal data from the date of collection for as long as it is necessary to fulfill the Purposes or to comply with the law or legal obligations by SRS. SRS shall stop processing your personal data when you write to SRS using the contact details in paragraph 5 above to withdraw your consent. 8. At the time the personal data is collected, it is obligatory that you supply us the personal data requested for by us. Failure to supply us with your personal data may render us unable to carry out the Purposes. 9. You undertake and warrant to SRS that your personal data is accurate, complete, not misleading and up-to-date. The onus is on you to update SRS if your personal data has changed. 10. SRS reserves the right to update and amend this Personal Data Notice from time to time. SRS will notify you of any changes via announcement on SRS s website or through other reasonable means of providing notice as SRS may deem appropriate. Any changes to this Personal Data Notice will be effective immediately upon notice to you. PERIBADI Notis Data Peribadi SRS Healthcare Research Consultancy Sdn Bhd ( SRS atau kami ) dikehendaki untuk mematuhi Akta Perlindungan Data Peribadi 2010 (dirujuk sebagai Akta ) yang mengawalselia pemprosesan data peribadi dalam transaksi komersial. Untuk tujuan Notis Data Peribadi ini, terma-terma data peribadi dan pemprosesan akan mempunyai maksud sepertimana ditakrifkan dalam Akta. Notis Data Peribadi ini adalah terpakai terhadap mana-mana pihak yang data peribadinya diproses oleh SRS atau bagi pihak SRS. 1. Notis Data Peribadi ini bertujuan untuk memaklumkan anda bagaimana data peribadi anda diproses oleh SRS. SRS HEALTHCARE RESEARCH CONSULTANCY SDN BHD ( X) 5

6 2. Data Peribadi anda yang kami proses mungkin termasuk nama, jawatan, nama syarikat, maklumat perhubungan, alamat emel dan apa-apa data peribadi lain yang diperlukan untuk tujuan yang dinyatakan dalam perenggan 3 di bawah. 3. SRS akan menggunakan data peribadi anda untuk tujuan berikut (selepas ini akan dirujuk sebagai Tujuan ):(a) untuk memproses borang pendaftaran anda untuk program latihan (termasuk persidangan) yang dianjurkan oleh SRS dan anjuran kerjasama entiti-entiti yang lain serta untuk tujuan pentadbiran seperti senarai kehadiran, pengeluaran invois, resit dan sijil kehadiran;(b) untuk berkomunikasi dengan anda tentang pengesahan program latihan dan sebarang perkara yang berkaitan dengan program latihan/persidangan SRS;(c) untuk memaklumkan anda apa-apa perubahan pada program latihan yang melibatkan anda; (d) untuk penghantaran resit dan sijil kehadiran melalui pos atau emel; (e) untuk menjawab pertanyaan atau maklum balas anda dan (f) untuk lain-lain tujuan pentadbiran yang berkaitan dengan Tujuan yang dinyatakan di atas. 4. Data peribadi anda dikumpul dari pelbagai sumber. Ini termasuk maklumat yang telah anda berikan kepada kami, maklumat daripada pihak-pihak ketiga dan maklumat dalam domain awam. 5. Anda boleh mengakses dan meminta untuk membuat perubahan kepada data peribadi anda. Sila hubungi kami sekiranya anda mempunyai apa-apa pertanyaan atau aduan berkenaan dengan data peribadi anda melalui cara di bawah: Hubungi: Alamat Pos: Manager, SRS Training Division. SRS Healthcare Research Consultancy Sdn. Bhd. C-6-12 Streetmall, One South, Jalan OS, Taman Serdang Perdana, Seksyen Seri Kembangan, Selangor, Malaysia No Telephon: No Faks: E-mel: Selaras dengan Akta:(a) SRS boleh mengenakan anda bayaran sehingga RM10 (untuk data peribadi) dan RM30 (untuk data peribadi yang sulit) untuk memproses sebarang permintaan untuk mengakses data peribadi anda; dan (b) SRS boleh menolak permintaan anda untuk mengakses atau membuat pembetulan kepada data peribadi anda. 6. Data Peribadi anda mungkin didedahkan:(i) kepada pembekal luar (terhad kepada alamat emel) bagi tujuan penghantaran emel kepada anda bagi pihak SRS - SRS HEALTHCARE RESEARCH CONSULTANCY SDN BHD ( X) 6

7 digunapakai untuk ahli SRS, pelajar dan affiliate sahaja; (ii) atau bila dibenarkan oleh undang undang atau atas perintah Mahkamah 7. SRS akan menyimpan data peribadi anda selama perlu bagi mencapai Tujuan di atas atau mengikut kehendak undang-undang atau keperluan undang-undang SRS. SRS akan berhenti memproses Data Peribadi anda apabila anda mengemukakan permintaan secara bertulis kepada SRS melalui maklumat perhubungan di perenggan 5 di atas untuk menarik balik kebenaran anda. 8. Semasa pengumpulan data peribadi, adalah wajib bagi anda membekalkan data peribadi anda seperti yang diminta oleh pihak kami. Kegagalan untuk membekalkan kami dengan data peribadi anda boleh menyebabkan Tujuan di atas tidak dapat dilaksanakan. 9. Anda akur dan memberi akuan kepada SRS bahawasanya data peribadi anda adalah tepat, lengkap, tidak mengelirukan dan terkini. Adalah menjadi tanggungjawab anda untuk memaklumkan SRS sebarang perubahan maklumat peribadi. 10. SRS mempunyai hak untuk mengemaskini dan mengubah Notis Data Peribadi dari masa ke semasa. SRS akan memberitahu sebarang perubahan melalui laman sesawang SRS atau melalui sebarang kaedah bersesuaian.. Sebarang perubahan pada Notis Data Peribadi akan berkuatkuasa serta merta selepas notis dikeluarkan. SRS HEALTHCARE RESEARCH CONSULTANCY SDN BHD ( X) 7

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