MENTION2013 International Conference

26th 28th November 2013

REGISTRATION FORM

1. PERSONAL INFORMATION
Surname: ________________________________

Given Name: ___________________________

Title : ___________________________________

Position: _______________________________

Organization :________________________________________________________________________
Mailing Address :

Home

Office

___________________________________________________________________________________
__________________________________________________________________________________
___________________________________________________________________________________

Phone (Office) : ___________________________

E-mail : _______________________________

Mobile : _________________________________

Fax : __________________________________

2. REGISTRATION
Registration Type:

Presenter

Participant

Conference Fee
INTERNATIONAL DELEGATES
Regular Presenter
Regular Participant
Postgraduate Students *
MALAYSIAN DELEGATES
Regular Presenter
Regular Participant
Postgraduate Students *
Undergraduate Students *
*Full- time/part-time students are required to produce a valid student
card.
1

USD300
USD200
USD100
MYR350
MYR150
MYR100
MYR50
identification or registration

3. PAYMENT
Payment Mode

No

USD/MYR

Telegraphic/ Wired Transfer/EFT

Bank Drafts/ Cheque (To Bendahari UKM)
LO
Cash
Payment by telegraphic/ wired transfer/ EFT, addressed to UNIVERSITI KEBANGSAAN MALAYSIA

Account no : 1215-0001187-10-1
Bank name : CIMB Bank Berhad
Swift Code
: CIBB MYKL (for overseas transfer only)
Bank Address : CIMB Berhad
Lot 1.04 & 1.05, level 1,
Wisma UNIKEB
43600 Bangi, Selangor
MALAYSIA

(Important) : Please indicate the payment is for MENTION2013 International Conference

4.

Remittance slip must be scanned with the registration form to the Secretariat. All payment for
the conference registration must be made in USD/Malaysian Ringgit (MYR).
Registration will only be confirmed upon receipt of full payment.
Please e-mail the completed registration form with a scanned payment notice to the
MENTION2013 Conference Secretariat.

SPECIAL REQUEST
Vegetarian

5.

ACCOMODATION

For accommodation, please check out the conference website at www.ukm.my/mention13 for the
nearby hotels.