REGISTRATION FORM

PARTICIPANT DETAILS

No Name (Title) Designation/Department Tel No Email






COMPANY DETAILS
Company/Organization Name :
Address :

CONTACT PERSON DETAILS
Name :
Designation : Tel No:

WORKSHOP FEE : RM 300.00

PAYMENT METHOD & CONTACT PERSON DETAILS (For Billing Purpose)
(Please tick where applicable)

For Local Participant, you can pay via:

Note
All payments made by bank transfer have to be
net of all bank charges. Please note that all bank
charges must be fully covered by the
participants. Full payment is required before the
workshop. Only those participants whose fees
have been paid in full will be allowed to
participate.
Cancellation & Refund Policy
If any registered participant cannot attend the
workshop, substitutions/replacements are
welcome at any time. Replacement should be
notified in writing to the workshop secretariat.
Fees paid are not refundable but can be used for
future Research & Publication Camp workshops.
Telegraphic Transfer PO/LO

Invoice, please send us an invoice with the details bellow:

Name:
Designation : Tel No:
Faks No : Email :
Billing Address :

Please Pay to:
Beneficiary Name: BENDAHARI UNIVERSITI MALAYA
Account Number: 14400004005053 (CIMB)

To register, please email this form with a copy of your proof of payment of RM300 by 12 November 2014 to:

Dr Lau Poh Li
Faculty of Education
University of Malaya
Tel No: 03-79675178
Email: janicepolly@um.edu.my



Or
Puan Faridah Taib
Faculty of Education
University of Malaya
Tel No: 03-79675079
Faks: 03-79675089