IFLA-APR 2014 INTERNATIONAL STUDENT DESIGN COMPETITION DECLARATION FORM

Please complete the declaration and save as an un-editable PDF file. This file is to be submitted together with your entry. Authorship Declaration I/We declare that I/we are the true authors of the work submitted and have met all the competition requirements. I/We declare that we are currently enrolled as student/s in a Landscape Architecture programme that is recognized by the professional body/ institute in my country, or are students studying landscape architecture where there is no programme specifically identified as landscape. I/We declare that I/we shall not have the submission published prior to notification of the jurys final decision. # 1 2 3 4 5 Authors Full Name University/Institution Programme/ Department

Contact for Correspondence: to be used to contact winning

teams and for other correspondence

Payment Methods:
Fax or email: Please fax or email completed form to ILAM, together with the bank-in payment slip and credit card authorization to:
Bank Name: CIMB Account Name: ILAM EVENTS Account Num: 12150010843051 Swift No: CIBBMYKL CIMB Bank, Universiti Putra Malaysia, Ground Floor, Block B, UPM 43400 Serdang, Selangor MALAYSIA

Full Name for Contact: ____________________________________________ Address: _________________________________________________ _________________________________________________ _________________________________________________ Postal Code: ______________ State: _________________ Country: ______________________ Tel Num: ________________Fax Num: _______________ Email: ________________________ Endorsement by Dean of Faculty or Head of School:
I certify that the author/s and/ or team leader is currently a student in the Landscape Architecture programme of this University or students studying landscape architecture where there is no programme specifically identified as landscape architecture.

Print Name: _________________________ Designation: _____________________ Signature: ___________________Date: ______________ University/ School Official Stamp:

AUTHORIZATION FOR CREDIT CARD PAYMENT Student Name: _______________________ Amount (US$): ______________ Credit Card type: Master Card/ VISA/ American Express Card Holder Name: ____________________ Credit Card Number: ____/ ____/____/____ Expiry Date: ___/____ Card Holder Signature: ______________
Note: All payments made will not be refunded

Submission Enquiries

Payment Enquiries

INSTITUTE OF LANDSCAPE ARCHITECT MALAYSIA (ILAM) Department of Landscape Architecture, 1-10-3, PRESINCT ALAMI, Pusat Perniagaan Worldwide 2, Persiaran Faculty of Built Environment, Universiti Teknologi Malaysia, Akuatik, Seksyen 13, 40100 Shah Alam, Selangor. MAlAYSIA 81310 Skudai Johor MALAYSIA Tel: (60)3-5523 4638/ (60)13-2020 827 Fax: (60)3-55190827 Att: Assoc Prof Zainul Hakim Mohd Zain Email: ilamalaysia1981@gmail.com Tel: (60)7-5557355 hp: (60)12-7716524 Fax: (60)7-5557411 Email: zainulhakim@gmail.com/ drsapura@gmail.com / b-hamidah@utm.my

Office Use only:

Entry Num: ______________ Receipt Number : _______________