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]