Registration Form FIRST PCBET International Conference “Integrating Communities” October 7- 9, 2014 Centre for Communication, Teaching, and Learning Institut Teknologi Brunei Jalan Tungku Link, Gadong, BE1410 Brunei Darussalam Tel: +673-2461020 Fax +673-2461035/6 Email: [email protected] www.itb.edu.bn/pcbet Full Name: _______________________________________________ (Name for badge) _____________________________ University/Organization: _________________________________________________________________________________ Preferred Mailing Address: _______________________________________________________________________________ City: ________________________________ State/Province: ______________________ Zip/Postal Code: _______________ Country: _____________________________ Telephone: ________________________ Fax: __ ________________________ Email: _________________________________________________________________ Signature: ___________________________________________________ CONFERENCE FEES 1. Registration Fees (Includes all conference materials, conference dinner, lunches and teas). PLEASE CHECK APPROPRIATE REGISTRATION FEE: 2. BEFORE/ON AUGUST 31, 2014 AFTER AUGUST 31, 2014 International participants  USD 200  USD 300 Local participants  USD 100  USD 100 Indicate dietary preference:  No preference  Vegetarian meal 3. Cancellations/Changes and Refunds: Fees will not be refunded. 4. PAYMENT METHOD Cheque or Money Order must be in USD currency payable to: Institut Teknologi Brunei. Registration confirmation/ receipt and further information will be e-mailed to participants. You may use this account detail for your reference when you make your payment: Account Name Account No. Bank Bank Address Swift Code : Institut Teknologi Brunei : 00-001-01-0045184 : Bank Islam Brunei Darussalam : Lot 159, Jalan Pemancha, Bandar Seri Begawan BS8711, Negara Brunei Darussalam : BIBDBNBB Full payment must be received before registration is processed and participants must email a scanned copy of the bank slip or bank advice of telegraphic transfers form to the Secretariat. Participants are responsible for retaining this copy and must bring it as proof of payment on the first day of the conference.