Program of Self Expression Through Expressive Artwork: Creative Healing Theory

Into Practice (SETEA)

REGISTRATION FORM
All participants are required to complete this registration form. You can submit the form by
fax (+6 082 58 1 950), or email to sslydiawati@unimas.my Please submit the form together
with the payment transaction slip to confirm your attendance and participation.
SECTION 1: CONTACT INFORMATION
1) Title:
Madam

First Name:
Helen

Last Name:
Thomas

2) Title:

First Name:

Last Name:

3) Title:

First Name:

Last Name:

4) Title:

First Name:

Last Name:

5) Title:

First Name:

Last Name:

Institutional/Organization:
SK SEMENGGOK
Mailing Address:
KM-20,JALAN KUCHING-SERIAN,93250, KUCHING.
Email:
libra_011080@yahoo.com

Telephone:
082-614178 (Sekolah)
0128559123 (HP)

Fax:

SECTION 2: PACKAGE INFORMATION (Tick Relevant Package)

Package A (without accommodation)
Normal Fees paid from 27 April 2016 onwards/until 11 May 2016
th

th

RM500.00
per person
RM420.00
per person

Package B (without accommodation)

Early Bird Fees paid before 27th April 2016
Package C (without accommodation)
Group Registration Fees for 5 members paid before 27 April 2016
th

RM400.00
per person

RM300.00
per person

Package D (without accommodation)

Special Fees for UNIMAS Staffs or UNIMAS Students

SECTION 3: DECLARATION

I hereby declare that the above information is true and accurate to the best of my knowledge.
SIGNED:

DATE: 6 /5/2016