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									         4th Annual American Business Research Conference
     Date: 4-5 June, 2012 | Venue: Adelphi University, Manhattan, NY, USA
                                 Conference Registration Form
All participants are required to complete this registration form and return in MS Word format to Ms.
Nuha Jahan via uspapcon@gmail.com or Fax to: +61 3 9702 0122

SECTION 1: CONTACT INFORMATION

 TITLE:                 Mr            Mrs            Miss          Ms            Dr           Prof.        Other, specify:

 FIRST NAME:                                                                LAST NAME:

 ADDRESS:                                                                   MAIN TELEPHONE:
                                                                            WORK TELEPHONE
                                                                            (if different)
                                                                            HOME TELEPHONE

 TOWN/CITY:                                                                 MOBILE PHONE:

 POST CODE;                                                                 PRIMARY EMAIL:
                                                                            SECONDARY
 COUNTRY;
                                                                            EMAIL:
 FACULTY/DEPARTMENT/SCHOOL:
 AFFILIATION (NAME OF
 UNIVERSITY/INSTITUTE):
 BROAD FIELD OF RESEARCH
 (eg. Banking, Management, etc):
 Are you willing to serve as a                                              Are you willing to work as
                                              Yes           No                                                     Yes          No
 session chair:                                                             a reviewer:
 How did you hear about this                 Direct Email         Websites (Please Specify) :
 conference?                                 Other (Please Specifiy) :

SECTION 2: PAPER PRESENTATION

                                                                            If you are presenting a
 Are you presenting a paper or                Presenting Paper
                                                                            paper, how many are you            1            2
 participating as an observer?                Observer
                                                                            presenting?
 Please provide the paper                                                   Do you have a                       Yes       No
 number(s) assigned to you in the                                           preference for paper            If Yes- which date:
 acceptance letter(s):                                                      presentation date?                 4 June     5 June

                                             Yes            No
 Would you like your paper to be
 included in the online refereed           If Yes- Please choose what you would like to upload to the proceedings
 conference proceedings?                      Abstract      Full Paper


SECTION 3: PAYMENT INFORMATION

Please indicate which code and description you are paying for (refer to the fee schedule) and tick the
payment option you choose to pay by. For credit card payments, please fill in all relevant information below.

 Code:               Description:                                                                     Amount:       USD $
            Credit Card                               International Transfer                               Paypal
                                                                                              Pay to: njahanwbi@gmail.com (for
 Type of Card:      Mastercard      Visa      Pay to: World Business Institute
                                                                                              Paypal account Holders)
 Name on Card:                                Branch No: 033609 | Account No. 382353          OR
                                                                                              Email: Nuha Jahan via
 Card Number:                                 Swift Code: WPACAU2S
                                                                                              njahanwbi@gmail.com
                                                                                              For non Paypal account holders for an
 Expiry Date:                                 Bank Name: Westpac Banking Corporation
                                                                                              invoice to be emailed to you
 PLEASE NOTE: The Credit Card
                                              Address: 27 High Street, Berwick,
 will be processed by Business Care
                                              Melbourne, Victoria 3806, Australia
 Australia Pty Ltd, Australia


 Declaration: I HEREBY DECLARE THAT THE ABOVE INFORMATION ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.

 SIGNED:
                                                                                      DATE:
 (or write name here)

PLEASE NOTE: Receipts will be provided on the conference registration day (4 June 2012) unless
urgently required.

								
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