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REGISTRATION FORM

Course Title : Short Course on Mastering the Art of Journal Publication


A Versatile Approach
26 February 2015
RIO Seminar Room 2, Block L, Universiti Teknologi PETRONAS
Course Fees : RM 750.00 (Professionals), or
RM 500.00 (Students)
To register : Please scan and email this form together with proof of
Payment or a copy of company undertaking letter to
nurulwahida@petronas.com.my
PARTICIPANT DETAILS
Participant Names

Designation/
Position

Contact No and
Email Address

1.
2.
3.
4.

CONTACT DETAILS (FOR BILLING PURPOSES)

Company Name

Company Address

Contact Person

Tel /Fax No

Email Address

Signature

Date

Company Stamp

Please mark X below


Professional
Student

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