Facsimile to:
Email to:
signatures)
IFIP Summer School on NEXT GENERATION PARADIGMS IN IT
Conference Secretariat + 8437593147
vu.phuong.ms@gmail.com and o.hussain@adfa.edu.au(facsimile required for credit card
*** Please complete this form in capital letters
Summer School on
NEXT GENERATION PARADIGMS IN IT
Registration Form
August 2014, Kuala Lumpur, Malaysia
http://www.ifip-tc12.digitial-ecology.org
Title/Salutation:
First Name:
Last Name:
Organisation / Affiliation:
Address:
Country:
Email Address:
Telephone:
Fax Number:
If participant is a member of an IFIP member society such as IEEE, ACM,
provide membership number
The registration fee for the conference includes a copy of Summer School Slides on USB Stick, coffee breaks
and lunch
REGISTRATION FEE
IFIP Member Society Member
Non-Member
Student
Regular
RM 350
RM 450
RM 200
Earlybird (before June 30th, 2014)
RM300
RM 400
RM100
Amount
A.1
A.2
A.3
Student registration requires a copy of the student card or any document certifying current enrolment status.
TOTAL PAYMENT =
€
REGISTRATION FORM – PAGE 2
Summer School on
NEXT GENERATION PARADIGMS IN IT
August 2014, Kuala Lumpur, Malaysia
http://www.ifip-tc12.digitial-ecology.org
Total Payment in RM can be made by credit card (VISA or MasterCard) or international bank transfer. Please
indicate preferred payment option by ticking the appropriate box.
□ Credit Card
 Visa
Credit Card
 MasterCard
Name as it appears on Credit Card:
Card Number:
CVC Number:
Expiration Date:
□ Bank Transfer
/
Payment is possible by bank transfer to the following bank account
Bank: Maybank
Address: Dataran Maybank, Bangsar, Kuala Lumpur, Malaysia
Swift Code: MBBEMYKL
Account Number: 514253341351
Account holder: Phoenix & Lion (M) Sdn. Bhd.
Important: Please indicate the code “XXXX”, your name and organization
Payments should be made in RM and without charges to the beneficiary.
Remember to send a copy of the bank transfer receipt by fax
to + 8437593147
Signature of Card Holder:
Date:
Do you require a letter for Visa purposes? If so, please email full details to tharam.dillon7@gmail.com.
Registration confirmation will be sent to you upon acceptance of full payment.
Please fax this form to:
IFIP Summer School Conference Secretariat + 8437593147