Please tick where appropriate:

YES, I would like to join for

Participant Information:

Payment Details:

Admission Fee: RM100/pax
Please bank in the cheque to Malayan Banking Berhad (A/C No.: 5-12446-20273-7) and fax the bank slip (noted NINA Innovation Incubation Week 2010 & kindly state your full name & contact details) to 603- 2297 5390 OR via cheque made payable to Persatuan Rangkaian Inkubator Kebangsaan and send to:

NINA Innovation Incubation Week 2010
National Incubator Network Association (NINA) Secretariat
c/o MAD Incubator Sdn. Bhd.
Lot 2-1A, Support Services,
Technology Park Malaysia,
Lebuhraya Puchong-Sg. Besi, Bukit Jalil,
57000 Kuala Lumpur.

For enquiries, please call Alice Foong at 603- 8994 1750.