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
* 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.