REGISTRATION FORM Title : Full Name : Organization : Address : Postcode : Telephone : E-mail : Prof. Assoc. Prof. Dr. Mr. City : Mrs. Ms. State : Mobile : Fax : Alternate E-mail : Category and Fees : Please mark (X) for your chosen package. CATEGORIES PRESENTERS/PARTICIPANTS (LOCAL) PRESENTERS/PARTICIPANTS (INTERNATIONAL) PRESENTERS/PARTICIPANTS (LOCAL STUDENTS) PRESENTERS/PARTICIPANTS (INTERNATIONAL STUDENTS) REGISTRATION FEE EARLY BIRD UNTIL 1 MAY 2015 MYR 850 USD 305 MYR 750 USD 265 NORMAL PRICE MYR 950 USD 335 MYR 850 USD 290 For student package, kindly scan your Student ID and attach the document with the registration form for verification purpose. Payment Method : Payment Option #1 (via Telegraphic Transfer or Direct Deposit) Payment Option #2 (via Banker’s Cheque or Bank Draft) Payment Option #1(via Telegraphic Transfer or Direct Deposit) - BANK ISLAM MALAYSIA BERHAD (Account No: 12029010065953) Payment Option #2 (via Banker’s Cheque or Bank Draft) – Made Payable to – TETUAN YAYASAN KUIS No personal cheque is allowed. Registration fee must be paid in advance of the event. Walk-in delegates, with payments will be admitted on space availability basis. Account Information Details Account Number : 12029010065953 Account Name : TETUAN YAYASAN KUIS Bank Address : Bank Islam Malaysia Berhad , Cawangan Bandar Baru Bangi, No. 2 & 4, Jalan 6C/7, 43650 Bandar Baru Bangi, Selangor. SWIFT Code: BIMBMYKL CANCELLATION POLICY Substitution is allowed for registered participants. Take note that payment must be made on or before the early bird due date to qualify for discount. The following cancellation policy will be imposed if cancellation is made by: 1. Cancelation 6 weeks before the event : 100% refund 2. Cancellation less than 6 weeks before the event : 50% refund 3. Cancellation less than 1 week before the event : No refund Kindly submit your registration form with proof of full payment to: ICCW2014 Conference Secretariat Yayasan KUIS, International Islamic University College Selangor (KUIS) E-mail: [email protected]
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