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REGISTRATION FORM

Title :(Dato/Datin/Prof/Assoc Prof/Dr/Sir/Mr/Ms)

Full Name :

Organization :

Address :

Postcode : City: State:

Telephone : Mobile: Fax:

E-mail : Alternate E-mail:

Paper No : Paper Title:

Category : Local Local International International


Student Participant Student Participant
Conference as : Paper Presenter Participant Only Session Chair: Interested Not Interested

Attend Conference: :
Attend Not Attend

Name to be printed on GSE 2014 certificate:

Fees : Please thick/remark the check box for your chosen package.
Early Bird Normal Fees
st st
Package Before 31 January 2014 After th 31 January 2014

STANDARD RATE USD 280 USD 330


(MYR 850) (MYR 950)
STUDENT RATE USD 250 USD 280
(Please email your student ID) (MYR 750) (MYR 850)
* Conference Fee comes with 1 lunch and 2 coffee breaks (2 days)
* All transaction in MYR base on 3.0 exchange rates with service charges
* Additional paper is chargeable at USD150 per paper Please visit the website for the online payment link
* For student package, please email your Student ID for verification purpose

World Conference Resources


Koperasi Kolej Universiti Islam Antarabangsa Selangor, Kolej Universiti Islam Antarabangsa Selangor, Bangi,
43000 Kajang, Selangor, Malaysia. Tel: +6019-3472420
Conferences E-mail: icasic.wcr@gmail.com web: www.worldconferences.net
Payment Method: Payment Option #1 (via Telegraphic Transfer or Direct Deposit)
Made payable to:
Account number : 562834627354
Account name : KOKISDAR
Bank: Maybank Islamic
Bank Address: No. 7 & 9, Jalan 9/9C, Seksyen 9, Bandar Baru Bangi, 43650
Bangi, Selangor , Malaysia
Swift code: MBISMYKL - MAYBANK ISLAMIC BERHAD
Payment Option #2 (via Bankers Cheque or Bank Draft)
Made payable to:
Account number : 562834627354
Account name : KOKISDAR
Bank: Maybank Islamic
Bank Address: No. 7 & 9, Jalan 9/9C, Seksyen 9, Bandar Baru Bangi, 43650
Bangi, Selangor , Malaysia
Swift code: MBISMYKL - MAYBANK ISLAMIC BERHAD

Please mail the transaction slip or bank slip after the payment has been made to:
mail: gse.wcr@gmail.com

Please mail the registration form to:


mail: gse.wcr@gmail.com

Cancellation Policy
Substitution is allowed for registered participants. Please note that payment must be made prior to the early
bird dateline above to qualify for early bird discount. Cancellation policy will be imposed if cancellation is made
by:

1. Cancelation before 6 weeks of the event 100%


2. Cancellation less than 5 weeks of the event 50%
3. Cancellation less than 1 week of the event -no refund

Registration Fee Detail

Registration fee must be paid in advance of the event. Walk-in delegates, with payments will be
admitted on space availability basis.

ACCOUNT INFORMATION DETAIL

Account number : 562834627354


Account name : KOKISDAR
Bank Address: No. 7 & 9, Jalan 9/9C, Seksyen 9, Bandar Baru Bangi, 43650 Bangi, Selangor, Malaysia

Swift code: MBISMYKL - MAYBANK ISLAMIC BERHAD

World Conference Resources


Koperasi Kolej Universiti Islam Antarabangsa Selangor, Kolej Universiti Islam Antarabangsa Selangor, Bangi,
43000 Kajang, Selangor, Malaysia. Tel: +6019-3472420
Conferences E-mail: icasic.wcr@gmail.com web: www.worldconferences.net