DOC - Universiti Utara Malaysia

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					Conference Registration Form
Please print your particulars in block letters.

Title :        Prof.               Assoc. Prof.            Dr.                 Mr.               Ms.

Family Name/Surname            :     ______________________________              First Name : ___________

Institutional Affiliation      :     _________________________________________________________

Mailing Address                :     _________________________________________________________
                                     _________________________________________________________
                                     _________________________________________________________

Telephone      :   _____________________                   Fax          :       _________________

E-mail         :   _____________________

Status of Participation :                Presenter               Participant

Title of Presentation :        _____________________________________________________________
                               _____________________________________________________________

Type of Presentation :               Paper            Poster            Workshop

Presentation Equipment Needed :                      OHP                             Flipchart

                                                      Computer & LCD                 TV & VCD Player

Dietary Preference :           Vegetarian            Non-Vegetarian



                            Method of Payment for Conference Registration Fee:


* Please enclose the payment together with the Conference Registration Form.
* Deadline for registration is 01 April 2007.

I hereby enclose a Bank Draft (Overseas participant)/Cheque/money Order*.

No: _________________________________ for the amount of RM/USD: ____________________

Payable to “Bendahari Universiti Utara Malaysia”.

* International participants: Please note that we cannot accept personal cheques as the form of
  payment.
* Please include charges (USD15/RM50) for the use of electronic equipment.
**A guarantee letter of payment (from sponsor/institution),preferably full payment is required
  by 25 February 2007 to ensure that the paper will be published as Proceedings.

				
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