REGISTRATION FORM

FIRST NAME LAST NAME DESIGNATION : : :

ORGANIZATION : /INSTITUTION SUPERVISORS NAME & EMAIL (For Postgraduate Student) ADDRESS POSTCODE COUNTRY : : :

STATE:

TELEPHONE NO. : EMAIL TITLE OF PAPER : :

FAX NO.:

CO-AUTHORS

PLEASE TICK IN APPROPRIATE SPACE/S BELOW I WISH TO [ ] present an oral paper [ ] present a poster [ ] be a participant REGISTRATION FEES CONFERENCE OF INTEREST: [ ] Computer Science [ ] Engineering Science [ ] Life Science [ ] Chemical and Physical Science [ ] Mathematics

CLASSIFICATION Local Participant Foreign Participant Local/Foreign Student

EARLY BIRD REGISTRATION (Before/On 31st March 2011) MYR550.00 USD250.00 MYR300.00/USD200.00

LATE REGISTRATION (After 31st March 2011 until 20t hJune 2011) MYR650.00 USD300.00 MYR300.00/USD200.00

Please tick where applicable. Registration fees cover the conference materials, program book with abstracts, conference proceeding, lunch and coffee break. *Student rate is entitled for those who holds student identification card/official letter from a recognized tertiary educational institution. METHOD OF PAYMENT: [ ] [ ] [ ] Cheque Telegraphic Transfer Local Order [ ] [ ] Bank drafts Direct Bank Transfer

Kindly fax/email/mail us a copy of your Telegraphic Transfer or Direct Bank Transfer receipt as a proof of payment for UMTAS 2011 registration. For further information or assistance please contact us.

SIGNATURE: ____________________________ MODE OF PAYMENT 1. 2.

DATE: ____________________________

All bank drafts or cheque (Malaysian only) must be made payable to BENDAHARI UNIVERSITI MALAYSIA TERENGGANU and mailed to UMTAS 2011 Secretariat together with the registration form. Telegraphic Transfer or Direct Bank Transfer should be routed to: Account Name: UNIVERSITI MALAYSIA TERENGGANU

Account Number: 1302-0014175-05-5 Bank Name: CIMB Bank Berhad SWIFTCODE: CIBBMYKL

flyer UMTAS 2011 edited outline .indd 1

12/23/10 3:38 PM

flyer UMTAS 2011 edited outline .indd 2

12/23/10 3:38 PM