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    AISEC Registration Form

    Uploaded by

    Wina Apriyanti
    This document contains a registration form for an event with the following sections: Section A requests personal details such as name, gender, organization, address, country, phone number, and any special requirements. Section B lists the registration fees - $100 for international participants and RM300 for Malaysian participants. Section C is a declaration that must be signed and dated, authorizing the organizers to use the applicant's personal information for the purposes of the program. Payment can be made online by credit card or via bank transfer, with instructions provided for both methods and important deadlines of September 19th for submitting registration forms and proof of payment. Contact details are provided at the end for any inquiries.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    AISEC Registration Form

    Uploaded by

    Wina Apriyanti
    24 views2 pages
    This document contains a registration form for an event with the following sections: Section A requests personal details such as name, gender, organization, address, country, phone number, and any special requirements. Section B lists the registration fees - $100 for international participants and RM300 for Malaysian participants. Section C is a declaration that must be signed and dated, authorizing the organizers to use the applicant's personal information for the purposes of the program. Payment can be made online by credit card or via bank transfer, with instructions provided for both methods and important deadlines of September 19th for submitting registration forms and proof of payment. Contact details are provided at the end for any inquiries.

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    AISEC Registration Form.docx

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    This document contains a registration form for an event with the following sections: Section A requests personal details such as name, gender, organization, address, country, phone number, and any special requirements. Section B lists the registration fees - $100 for international participants and RM300 for Malaysian participants. Section C is a declaration that must be signed and dated, authorizing the organizers to use the applicant's personal information for the purposes of the program. Payment can be made online by credit card or via bank transfer, with instructions provided for both methods and important deadlines of September 19th for submitting registration forms and proof of payment. Contact details are provided at the end for any inquiries.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    24 views2 pages

    AISEC Registration Form

    Uploaded by

    Wina Apriyanti
    This document contains a registration form for an event with the following sections: Section A requests personal details such as name, gender, organization, address, country, phone number, and any special requirements. Section B lists the registration fees - $100 for international participants and RM300 for Malaysian participants. Section C is a declaration that must be signed and dated, authorizing the organizers to use the applicant's personal information for the purposes of the program. Payment can be made online by credit card or via bank transfer, with instructions provided for both methods and important deadlines of September 19th for submitting registration forms and proof of payment. Contact details are provided at the end for any inquiries.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    REGISTRATION FORM

    SECTION A:

    PERSONAL DETAILS

    Name:

    ________________________________________________________________________
    (First Name)
    (Middle name)
    (Last Name)
    Gender
    Male / Female
    Organization/ University
    ______________________________________________________
    Address
    _______________________________________________________________________
    _______________________________________________________________________
    ___________________________
    Postcode :
    ________________________
    ___________________________
    _____________________________________
    (Area Code)
    (Phone Number)
    Email
    _______________________________________________________________________
    Special Requirements: _____________________________________________________________
    (Food restriction, etc.)
    Country
    Phone:

    SECTION B: FEES (Please tick appropriate box):

    International Participant

    USD 100

    Malaysian Participant

    RM 300

    SECTION C: DECLARATION

    I hereby declare that the information provided in this application is true and complete in every detail. I authorize
    Universiti Utara Malaysia to handle and use my personal data/information for the purposes of the program.

    Signature:

    Date:

    ________________________________

    __________________

    Payment Method
    1. By Credit Card (Online)

    a. Browse UUM e-com (http://e-com.uum.edu.my/bend/paymode.jsp)


    b. Follow all required steps as instructed. The payment is (USD100 for international student & MYR300 for
    local student).

    c. Note : for 'payment for' choose other payment


    d. Note : for 'description' : key in AISEC16 (Presenter/Participation)
    e.

    Please print and keep the notification of payment made as proof of payment. Scan and email the proof
    of payment as soon as possible or before 19 September 2016 to the secretariat
    (aisecuum16@gmail.com). You also need to bring the original payment slip during the registration. You are
    required to show the proof of payment to the secretariat on the registration day of the conference/
    workshop/ colloquium. Failure to do so will result in your name being not listed as presenter/ participants.

    2. Telegraphic Transfer / Bank Transfer


    Transfer should be made to the following account:
    Account Name: UNIVERSITI UTARA MALAYSIA
    Account No.: 02093010000010
    Bank Name: BANK ISLAM MALAYSIA BERHAD
    SWIFT CODE: BIMBMYKL
    Please include in your payment:

    The total registration fees; wire transfer fees are the responsibility of the registrant (Registrants are
    required to bear the processing fee charged by their own bank and a third party agent (if any).

    Your organization's name as it appears in the reference section of your transfer

    Please write a remark "REGISTRATION FEE FOR AISEC 2016"


    Please forward a scanned copy of the telegraphic transfer receipt to AISEC16 Secretariat (aisecuum16@gmail.com with
    cc to mazida@uum.edu.my) or by fax to +604 9285310 for us to verify the transaction. Please kindly write down the
    participant's name, date and time of the transfer and country and city of origin.
    Kindly note that NO International Cheque will be accepted

    Kindly send or e-mail us the registration form and proof of your payment (for the purpose of verification) before
    19 September 2016.

    For further enquiries, please do not hesitate to contact:


    Dr. Mazida Ahmad

    : +6019-576 1252

    Dr. Bahtiar Mohamad

    : +604-9285020

    E-mail: aisecuum16@gmail.com
    Website: http://aisecuum16.weebly.com

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