|
|
|
 Date: 8-10 April 2012 | Venue: Novotel Hotel, Siam Centre, Bangkok, Thailand All participants are required to complete this registration form and return in MS Word format to Mr. Mahbub Bhuiyan bangkokpap@gmail.com or Fax to: +61 3 9702 0122 SECTION 1: CONTACT INFORMATION | TITLE: | Mr Mrs Miss Ms Dr Prof. Other, specify: | | FIRST NAME: | | LAST NAME: | | | ADDRESS: | | MAIN TELEPHONE: | | | | | WORK TELEPHONE (if different) | | | | | HOME TELEPHONE | | | TOWN/CITY: | | MOBILE PHONE: | | | POST CODE; | | PRIMARY EMAIL: | | | COUNTRY; | | SECONDARY EMAIL: | | | FACULTY/DEPARTMENT/SCHOOL: | | | AFFILIATION (NAME OF UNIVERSITY/INSTITUTE): | | | BROAD FIELD OF RESEARCH (eg. Banking, Management, etc): | | | Are you willing to serve as a session chair: | Yes No | Are you willing to work as a reviewer: | Yes No | | How did you hear about this conference? | Direct Email Websites (Please Specify) : Other (Please Specify) : | | | | | | | | SECTION 2: PAPER PRESENTATION | Are you presenting a paper or participating as an observer? | Presenting Paper Observer | | | Please provide the paper number(s) assigned to you in the acceptance letter(s): | | Would you like your paper to be included in the online refereed conference proceedings Yes or NO | SECTION 3: PAYMENT INFORMATION Please indicate which code and description you are paying for (refer to the fee schedule) and tick the payment option you choose to pay by. For credit card payments, please fill in all relevant information below. | Code: | | Description: | | Amount: | USD $ | | Credit Card | International Transfer | Paypal | | Type of Card: Mastercard Visa | Pay to: Business Care Australia Pty Ltd | Pay to: njahanwbi@gmail.com (for Paypal account Holders) | | Name on Card: | Account No: 033-090 - 303339 | OR | | Card Number: | Swift Code: WPACAU2S | Email: Nuha Jahan via njahanwbi@gmail.com | | Expiry Date: | Bank Name: Westpac Banking Corporation | For non Paypal account holders for an invoice to be emailed to you | | PLEASE NOTE: The Credit Card will be processed by Business Care Australia Pty Ltd, Australia | Address: 302 Clayton Road, Clayton, Melbourne, Victoria 3168, Australia | | | | | | | | | | | | Declaration: I HEREBY DECLARE THAT THE ABOVE INFORMATION ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. | | SIGNED: (or write name here) | | DATE: | | PLEASE NOTE: Receipts will be provided on the conference registration day (9 April 2012) unless urgently required. |
|
|