JUNIOR SCIENTIST DAY - CRIME SCENE INVESTIGATION

Date: 6 & 7 August 2019 (Tuesday & Wednesday)

Time: 8.30 am - 4.30 pm

Venue: Institute of Medical Molecular Biotechnology,

Faculty of Medicine,

Universiti Teknologi MARA,

Sg. Buloh Campus.

Sorry registration is closed. please email to juniorscientistday@gmail.com or contact Mrs Salina 03-61265085 or Mrs Norita 03-61265073 if you have inquiries.

Thank you

School's name & address*

Contact person*

Phone Number*

Area CodePhone Number

Office Phone Number*

Area CodePhone Number

Email*

example@example.com

Chosen date*

7 August 2019 (Wednesday)

Participant's details

Maximum registration per day is 80 participants. Please email to secretariat if you want to register more than 20 participants.

	Participant's name	Age	Guardian's name	Emergency phone no.
No. 1
No. 2
No. 3
No. 4
No. 5
No. 6
No. 7
No. 8
No. 9
No.10
No.11
No.12
No.13
No.14
No.15
No.16
No.17
No.18
No.19
No.20

Payment information:

Billing name & address (to appear on invoice and receipt):*

Please select a method of payment*

Bank TransferCash deposit machine

Fees*

RM120/person if register less than 10 personsRM100/person if register more than 10 persons

Pre-order the event T-Shirt (RM30)- optional *T-shirt will be given on the event day*

AgreeDisagree

No of T-shirt

Size T-Shirt

For group order, please state size and quantity

Total Amount (RM)*

Payment details

Payment can be made to:

Receipient: BENDAHARI UiTM
Account number: 14069-01-002-345-7
Account bank: Bank Islam (M) Berhad

Please e-mail your proof of payment to juniorscientistday@gmail.com attention Pn. Roslina Ali (03-61265101). Payment should de made before 22 July 2019. Official Receipt will be given on the program day

Food Allergy*

If YES please state:

Terms & Conditions

1. All participants must follow all rules and instructions given by the organizer during the event or emergency.
2. All participants must wear appropriate clothing with socks and shoes.
3. Some activities may involved lab animal, bacteria and chemical.

Consent*

I HEREBY AGREE TO ALLOW ALL THE PICTURES AND VIDEOS TAKEN DURING THE PROGRAM TO BE USED FOR PROMOTIONAL, ADVERTISING AND FOR THE PURPOSE OF LEARNING ACCORDING TO THE ‘JUNIOR SCIENTIST DAY’ TERMS & CONDITIONS

JUNIOR SCIENTIST DAY PROGRAM