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Universiti Malaysia Pahang | 14 November 2013 | Thursday

REGISTRATION FORM Title

: __________

Prof

Dr.

other: _____________

Mr.

Mrs.

Ms.

Name

: __________________________________________________________________________

Organisation/Institution

: __________________________________________________________________________

Full Address

: __________________________________________________________________________ __________________________________________________________________________

Postcode

: ___________________

Country : _______________________

Telephone Number

: ___________________

Fax number: ____________________

E-mail address

: ______________________________

Status of Participation

: Presenter MELTA Presenter

MELTA Participant Student Participant

Participant FOR PAPER/WORKSHOP PRESENTER ONLY

Tittle of Abstract : ___________________________________

STUDENT PARTICIPANT ONLY

Student ID

DIETARY REQUIREMENTS

Normal

Vegetarian REGISTRATION FEE

RM 150

Presenter

RM 120

MELTA Presenter

RM 100

Participant

RM 100

Student Participant

RM 80

MELTA Participant

: _______________________ PAYMENT INFORMATION

Option 1: Bank Transfer Bank transfer must be made without charges to the beneficiary, and payable to: Account holder Account No Bank Name

: Bendahari Universiti Malaysia Pahang : 556226102820 : Malayan Banking Berhad

Please email a scan copy of your bank transfer receipt and SeLLT2013 registration form to sellt2013@gmail.com or fax to +609549 3112. Bank draft and cheque will not be accepted for payment. Bank charges to be borne by payee. Option 2: Local Order (only applicable for Malaysian Goverment Agencies), please consult secretariat for more details. Please send a scanned copy of LO to secretariat sellt2013@gmail.com and original copy to the following address:

IMPORTANT NOTES

1. Seminar fees include all plenary and parallel sessions, forum, tea breaks, lunch and registration materials. 2. Please email a copy of your valid student card/other formal identification (for student only) to sellt2013@gmail.com 3. Prices are quoted in MYR. 4. For enquiries, please contact us at: sellt2013@gmail.com

Centre for Modern Languages and Human Sciences Universiti Malaysia Pahang Lebuhraya Tun Razak, 26300 Gambang, Kuantan, Pahang (Attn: Siti Norzaimalina bt. Abd. Majid LO No

: _____________________________

Amount MYR

: _____________________________

“Embracing Transformative Language Education to Empower Professionalism”


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