CinTELL

CInTeLL Exhibition Registration Form
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Title *

Prefix First Name Last Name
Institution *
Occupation/Designation *

Address *

Office Number *

- Area Code Phone Number
Mobile Number *

- Area Code Phone 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 *

Presenter Participant
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 *

Vegetarian Non-vegetarian Other option
Would you be interested in a tour around the Royal town of Pekan (limited to 40 pax)? *

Yes No
If Yes (Please provide your IC or Passport Number)
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CInTeLL Exhibition Registration Form