Registration Form

Name: Title:Institution:Address:City:State:Postcode:Country:Phone:Fax:Email:

[ ] Presenter[ ] Participant[ ] Student (Please attach a copy of your student ID forvalidation)

Payment

Method of payment (Please choose only one):[ ]

Bank Draft/Check/Money Order

[ ]

Local Order (L/O)

[ ]

Telegraphic Transfer

Further information; kindly please refer to the enclosed attachment fordetail information on fees and payment methods.

Terms and Conditions

I understand that the fee is not refundable if I withdraw after myregistration is accepted by the organiser but substitution of participant willbe allowed. If I fail to attend this conference, the fee paid would not berefunded.……………………………………………………………..Name :IC/Passport No. :Date:

Please return this form through mail/fax/email to:

+60129034614

FEES & PAYMENT

Early Bird (Payment before 1st May 2010)

MalaysianRM

PresenterRM400ParticipantRM400StudentRM350

Non-MalaysianUSD

PresenterUSD125ParticipantUSD125StudentUSD100

PAYMENT METHODS FOR CONFERENCE PARTICIPANTS

We provide several methods for payment of conference fees:

LOCAL PARTICIPANTS

For local participants, Bank Draft/Check/Money Order/Local Order (L/O) areaccepted and must be in Ringgit Malaysia (RM).Payment is to be made payable to the following

BANK ISLAM MALAYSIABERHAD

account:

KOLEJ UNIVERSITI ISLAM ANTARABANGSA SELANGORAccount No.: 1202 9010 0359 14

Fax the copy of payment slip to +

603-89254473

- (Puan Aisyah+60126034586)

Scan and email the slip toictconf@kuis.edu.my

Note: Please include the participant’s name and the purpose of paymentfor participation in the Regional Conference on Knowledge Integration inICT 2010.