REGISTRATION FORM

Name :_____________________________________ ( Capital Letter as in certificate ) IC Number :_____________________________________ Designation :_____________________________________ Address :_____________________________________ ______________________________________ ______________________________________ Office No. :_____________________________________ HP Number :_____________________________________ Email :_____________________________________ Yes No
CME and CPD Point will be awarded for those attending!

ORGANISING CHAIRMAN
Prof. Dato Dr. Lokman Saim

SCIENTIFIC CHAIRPERSON
Assoc. Prof. Dr. Goh Bee See

SECRETARY
Dr. Azida Zainal

4th ASEAN ACADEMY OF NEURO-OTOLOGY & AUDIOLOGY (AANOA) CONGRESS

Bridging the Gap between Theory and Clinical Practices

COMMITTEE MEMBERS
Assoc. Prof. Dr. Cila Umat Dr. Hasherah Mohd. Ibrahim Dr. Rafidah Mazlan Dr. Nur Dina Hashim Dr. Zara Nasseri Pn. Nor Shahrina Mohd Zawawi Pn. Wan Fazlina Wan Hashim En. Muhd Azhan Ubaidah

Vegetarian :

Method of Payment
Telegraphic Transfer (TT) Transfer to : UKM Kesihatan Sdn Bhd Bank : Malayan Banking Berhad Acc Number : 514132132925 Swift Code No. : MBBEMYKL Cheque Enclosed is my cheque for RM_______________, Payable to UKM Kesihatan Sdn Bhd ( Cheque No :_________________________ ) Credit Card The details of my credit card are as follow : Issuing Bank : Card : VISA / MASTERCARD Card No : PO/ Invoice Invoice No : Employer Signature/ Stamp :

REGISTRATION FEE
Early Bird Fee Category (before 29 Feb ) **extended date!** Late Bird Fee (After 29 Feb) On Site Fee

Date :19 21 April, 2012

Venue : Lecture Halls, Academic Block, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia.
ORGANISERS Department of Otorhinolaryngology- Head and Neck Surgery, UKM Medical Centre School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia Department of Medical Rehabilitation Services, UKM Medical Centre SECRETARIAT
Tel : 03-9173 5308, Fax : 03-9173 0476 Email : ukmches@gmail.com Website : www.ukmches.com.my

Specialist

RM550.00 USD170.00

RM600.00 USD200.00

RM700.00 USD220.00

Resident

RM200.00 USD65.00

RM300.00 USD95.00

RM350.00 USD100.00

Audiology and Speech Therapy

RM150.00 USD50.00

RM200.00 USD65.00

RM250.00 USD80.00

Email us : annoamalaysia@yahoo.com Website : aanoa2012.blogspot.com

MESSAGE FROM CHAIRMAN

It is indeed my pleasure to announce that the 4 th ASEAN Academy of Neurotology-Otology and Audiology (AANOA) Conference will be held on the 19th 21st April 2012. The conference will be held in Kuala Lumpur, a city that is modern, vibrant but still has kept many of its traditional identities. I would like to invite you to join us in Kuala Lumpur. This year the conference will be held independently so that the whole conference will be able to focus on the field of our interest i.e. otology, neurotology and audiology. There will also be emphasis on speech sciences. The organizing committee is putting in a lot of effort in preparing an excellent scientific programme. I would like to invite all of you to submit your abstracts for presentation soonest possible. This year there will be many teaching and training sessions, through live surgery, temporal bone dissection demonstrations, mini workshops and video-presentations. All these activities will be held at UKM Medical Centre, an academic medical centre with experience in providing excellent medical care and medical education. I am confident all participants will find this meeting a fruitful and interesting one. So, please keep the conference dates in your schedule for 2012. I look forward to wishing you Selamat Datang to Kuala Lumpur
International:

SPEAKERS
Dr Muaaz Tarabichi (UAE) Dr Teresa Ching (Australia) Dr Socialisman (Indonesia) Prof Dr Helmi Belfas (Indonesia) Prof Dr Low Wong Kein (Singapore) Dr Noberto Martinez (Phillipines) Dr Charlotte Chiong (Phillipines) Dr Suchitra Prasansuk (Thailand) Prof Dato Dr Lokman Saim (Malaysia) Prof Dr Asma Abdullah (Malaysia) Assoc Prof Dr Goh Bee See (Malaysia) Prof Dr Prepagaran (Malaysia) Dr Siti Sabzah (Malaysia) Prof Dr Siti Zamratol-Maisarah Mukari Assoc Prof Dr Kartini Ahmad Dr Basyariatul Fathi Othman (Malaysia) Dr Nor Haniza Abdul Wahat (Malaysia) Dr Philip Rajan (Malaysia) Dr Rafidah Mazlan (Malaysia)
8.30 - 9.00 9.00 - 10.00 10.00 - 10.30

DAY 2 ( Friday 20 April 2012 ) Plenary 2 Symposium 2 (Auditory Implants) Tea Break Temporal Bone Demonstration (Mastoidectomy) Lunch Free Papers Workshop 6 ( Facial Nerve Exploration) 8.00 - 10.00 Congress Dinner Workshop 7 ( Bimodal Fitting II ) Workshop 8 (Multilinguilism and hearing impairment) Workshop 4 ( Bimodal Fitting 1 ) Workshop 5 (Conducting an Effective Play Group)

10.30 - 12.30

Local:

12.30 - 2.30 2.30 - 3.30

3.30 - 5.00

PROGRAMME
DAY 1 ( Thursday 19 April 2012 ) 7.30 - 8.30 8.30 - 8.45 8.45 - 9.15 9.15 - 10.45 10.45 - 11.00 11.00 - 1.00 1.00 - 2.00 2.00 - 3.00 Lunch 1.30 - 2.30 Free Papers Workshop 1 (Otology Office 3.00 - 5.00 Procedures) Workshop 2 (High frequency acoustic immitance in babies) Workshop 3 (Working with families of children with hearing impairment) 5.00 Tea Break Registration Welcoming Speech Plenary 1 Symposium 1 (Cholesteatoma) Photo session & Tea Break Live Surgery (Stapes Surgery) 12.30 - 1.30 11.00 - 12.00 8.30 - 9.00 9.00 - 10.30 10.30 - 11.00

DAY 3 ( Saturday 21 April 2012 ) Plenary 3 Symposium 3 (Vertigo) Tea Break Workshop 9 (Paediatric Workshop 10 ( Calorics and Plenary 4 Prize-giving and Closing Ceremony Lunch Workshop 11 (Adult Habilitation)

12.00 - 12.30

PROF DATO DR LOKMAN SAIM

President of Asean Academy of Neurotology & Audiology, Chairman of 4th Asean Academy of Neurotology & Audiology.