ARCASIA SUMMER PROGRAMME 2018:

(Hosted by the International Islamic University Malaysia. (www.iium.edu.my)

29 December 2018 to 26 January 2019
Jointly organised by the Department of Architecture, International Islamic University
Malaysia (IIUM) and the Malaysian Institute of Architects (Pertubuhan Akitek Malaysia,
PAM)
ARCASIA SUMMER PROGRAMME 2018 REGISTRATION FORM

We would appreciate it if you could confirm your participation by returning this registration form by Friday 14 September 2018 to
Ms Nor Suryati Sulong, PAM Secretariat by email: suryati@pam.org.my

Personal Information
Surname (Family Name) : .……………………………… First Name (Given Name) : .…………………………………….

Title (Prof/Dr/Ar/Mr/Mrs/Ms/Miss) : .…………………… Preferred name on badge : .…………………………………….

Country : …………………………………………………. Passport no.: ……………………………………………………..

University : ………………………………………………………………………………………………………………………………………

Course programme : ……………………..........................................................................................................……………………….

Year of study : …………………………………………... Semester : ………………………………………………………..

Telephone No : .…………………………………………. Facsimile No.:.………………………………………………..…..

Mobile Telephone No.:………………………………….. Email.…………………………………………………………...….

1) Participation fee
Please tick your preference

USD 1,250.00 (twin sharing)

USD 1,350.00 (single room)

 fee includes accommodation from 29th December 2018 to 26th January 2019, travel insurance (within Malaysia
only), meals and registration fee. (Travelling cost from home country to the venue and return to be paid by the
participants)

Payment to be made payable to PERTUBUHAN AKITEK MALAYSIA to United Overseas Bank (M) Berhad, account
no. 167 901 028 5 (Swift Code: UOVBMYKL). Once payment is made, please email the proof of payment / bank slip
to suryati@pam.org.my.

2) Flight Details:
Arrival Date __________ Arrival Time __________ Flight No. _______________
Departure Date __________ Departure Time __________ Flight No. _______________

3) Special Requirements
(Dietary/Medical/Religious/Others – please state) ………………………………………………………

4) Emergency contact details

Name : ……………………………………………………. Relationship : …………………..…………………………
Mobile Telephone No.:………………………………….. Email.…………………………………………………...….