CinTELL

CInTeLL Exhibition Registration Form
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Title

PrefixFirst NameLast Name
Institution
Occupation/Designation
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Office Number

Area CodePhone Number
Mobile Number

Area CodePhone Number
Email
Category
Title of Innovation/Invention
Name of team members or individuals who you wish to appear on an award certificate including team leader
Abstract
Register As
Fees Table
Participation Status (refer fee table above)
Bank Account Details:

Account Name: Bendahari Universiti Malaysia Pahang
Account Number: 556235301457
Bank Name: Malayan Banking Berhad
Bank Address: No. 56, Jalan Sultan Abdullah, 26000 Pekan, Pahang
Swift Code: MBBEMYKL

All bank charges for conference fee is to be borne by the participant.

No refunds for cancellation after 30 April 2018.

Please send us your proof of payment by 30 April 2018 to secure your seat at icollt@ump.edu.my. You can also refer to our conference website for further details.
Special dietary needs

Other
Would you be interested in a tour around the Royal town of Pekan (limited to 40 pax)?
If Yes (Please provide your IC or Passport Number)
Upload abstract here

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CInTeLL Exhibition Registration Form