Regards, MIA e-Learning Administrator Membership Services MIA E-LEARNING MEMBER INDUCTION COURSE (e-MIC) PAYMENT BY CREDIT CARD: I, _______________________________, membership number (______________) hereby authorise MIA to charge RM180.00 (Ringgit Malaysia Hundred Eighty) to credit card for the above course. The details of primary card as follows: Details of your second credit card (in case your primary card is declined by the Bank) Issuing bank : _____________________ Issuing bank : _____________________ Card : VISA / MASTERCARD Card : VISA / MASTERCARD Card No. : ____________________ Card No. : ____________________ Card Expiry Date: ____________________ Card Expiry Date: ____________________ Signature of Cardholder : ___________________________________ Date : ___________________________________ Contact No : ___________________________________ Finance Use Only: Status: Charge Posting KIV
Regards, MIA e-Learning Administrator Membership Services MIA E-LEARNING MEMBER INDUCTION COURSE (e-MIC) PAYMENT BY CREDIT CARD: I, _______________________________, membership number (______________) hereby authorise MIA to charge RM180.00 (Ringgit Malaysia Hundred Eighty) to credit card for the above course. The details of primary card as follows: Details of your second credit card (in case your primary card is declined by the Bank) Issuing bank : _____________________ Card : VISA / MASTERCARD Card No. : ____________________ Card Expiry Date: ____________________ Issuing bank : _____________________ Card : VISA / MASTERCARD Card No. : ____________________ Card Expiry Date: ____________________ Signature of Cardholder : ___________________________________ Date : ___________________________________ Contact No : ___________________________________ Finance Use Only: Status: Charge Posting KIV
SURVEY%20FORM%20-%20Reminder.docx