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Registration Form Registration Form Document Transcript

  • SGGS INTERNATIONAL STUDENTS’ CONFERENCE 2010 UNIVERSITI SAINS MALAYSIA, PENANG, MALAYSIA 13TH – 16TH JUNE 2010 REGISTRATION FORM Please complete the Registration Form and send to the Conference Coordinator by post/fax or email before or by 13 May 2010. Postal Address: The Coordinator SGGS International Students’ Conference 2010 SMK(P) St George, Macalister Road 10450 Penang Malaysia Fax No: 60-42295886 (Attn: Conference Coordinator) Email Address: sggsconference2010@gmail.com to the Conference Coordinator  Please note that all correspondence regarding the conference will be by email if possible AND updates regarding the conference will be available on our website www.smkpstgeorge.edu.my A. PARTICULARS OF SCHOOL (Please type or print clearly in CAPITAL LETTERS) 1. Name of School: ____________________________________________________ 2. Name of Headmaster/Headmistress: __________________________________ 3. Postal Address: ________________________________________________________ ________________________________________________________ ________________________________________________________ 4. Telephone No: ____________________ 5. Handphone No. ____________________ 6. Fax No: ____________________ 7. Email Address: ____________________ 1
  • B. PARTICULARS OF DELEGATES Student Delegate 1: 1. Name: ___________________________________ 2. Sex: ___________ 3. Age: ____________ 4. I/C or Passport No.: ___________ 5. Name for conference name tag: ________________________________________ 6. Special Diet (such as vegetarian meals or meals without beef): _________________ (Please note that all meals served are halal.) 7. Special Requirements (such as for wheel chair users, blind or visually impaired persons and others): ______________________________________________________________________ Student Delegate 2: 1. Name: ___________________________________ 2. Sex: ___________ 3. Age: ____________ 4. I/C or Passport No.: ___________ 5. Name for conference name tag: ________________________________________ 6. Special Diet (such as vegetarian meals or meals without beef): _________________ (Please note that all meals served are halal.) 7. Special Requirements (such as for wheel chair users, blind or visually impaired persons and others): ______________________________________________________________________ Student Delegate 3: 1. Name: ___________________________________ 2. Sex: ___________ 3. Age: ____________ 4. I/C or Passport No.: ___________ 5. Name for conference name tag: ________________________________________ 6. Special Diet (such as vegetarian meals or meals without beef): _________________ (Please note that all meals served are halal.) 7. Special Requirements (such as for wheel chair users, blind or visually impaired persons and others): ______________________________________________________________________ 2
  • Teacher Escort: 1. Name: ___________________________________ 2. Sex: ___________ 3. Age: ____________ 4. I/C or Passport No.: ___________ 5. Name for conference name tag: ________________________________________ 6. Special Diet (such as vegetarian meals or meals without beef): _________________ (Please note that all meals served are halal.) 7. Special Requirements (such as for wheel chair users, blind or visually impaired persons and others): ______________________________________________________________________ C. REGISTRATION DETAILS: (Please tick the appropriate box.) Type of Registration Participants from local or overseas schools Total USD80 X …… (no. of delegates) USD …… Registration A EUR60 X …… (no. of delegates) EUR …… (before 13 April, 2010) RM250 X …… (no. of delegates) RM …… USD90 X …… (no. of delegates) USD …… Registration B EUR70 X …… (no. of delegates) EUR …… (after 13 April, 2010) RM300 X …… (no. of delegates) RM …… Grand Total Only registration forms with payment will be accepted and registered. 3 View slide
  • B. PAYMENT METHOD: (Please tick the appropriate box.) BANK DETAILS: Name of the account: SEK MEN PEREMPUAN ST GEORGE A/C No.: 007068302002 Name of Bank: Maybank Pulau Tikus, Penang, Malaysia Payment into Bank Account directly Date of payment ______________________ (Please send a clear legible photocopy of the stamped bank pay-in slip as proof of payment along with your registration form.) Bank Draft Bank Draft No. ______________________ Date of Bank Draft: ______________________ Amount: ______________________ Date of Despatch: ______________________ Electronic Transfer Date of Transfer: ______________________ Amount Transferred: ______________________ Reference Number, if any; ______________________ 4 View slide
  • C. STUDENT PARTICIPATION All students are encouraged to take an active part at the conference by being one of the following so as to benefit most from the conference: (Please tick the appropriate box.) Chairperson (To chair the keynote address, plenary sessions, workshops or concurrent sessions) Name(s): ___________________________________________________ Rapporteur (To record the proceedings of the keynote address, plenary sessions, workshops or concurrent sessions) Name(s): ___________________________________________________ Respondent (To respond to the paper presentation of the keynote speaker or plenary session speaker) Name(s): ___________________________________________________ Presenter of Free Papers (Please take note of the closing date for abstract submission) Name(s): ___________________________________________________ ** As the response to the above may exceed the needs of the conference, the organisers will have to make a final selection and delegates will be informed in due course of the role that they have at the conference. Presenters of Free Papers will be duly informed whether their papers are accepted for presentation. Thank you very much and we look forward to seeing you at the conference. 5