Registration Form

Registration Form
FIRST PCBET International Conference
“Integrating Communities”
October 7- 9, 2014
Centre for Communication, Teaching, and Learning
Institut Teknologi Brunei
Jalan Tungku Link, Gadong, BE1410
Brunei Darussalam
Tel: +673-2461020
Fax +673-2461035/6
Email: [email protected]
www.itb.edu.bn/pcbet
Full Name: _______________________________________________ (Name for badge) _____________________________
University/Organization: _________________________________________________________________________________
Preferred Mailing Address: _______________________________________________________________________________
City: ________________________________ State/Province: ______________________ Zip/Postal Code: _______________
Country: _____________________________ Telephone: ________________________ Fax: __ ________________________
Email: _________________________________________________________________
Signature: ___________________________________________________
CONFERENCE FEES
1.
Registration Fees (Includes all conference materials, conference dinner, lunches and teas).
PLEASE CHECK APPROPRIATE REGISTRATION FEE:
2.
BEFORE/ON
AUGUST 31, 2014
AFTER AUGUST 31, 2014
International participants
 USD 200
 USD 300
Local participants
 USD 100
 USD 100
Indicate dietary preference:
 No preference
 Vegetarian meal
3.
Cancellations/Changes and Refunds: Fees will not be refunded.
4.
PAYMENT METHOD Cheque or Money Order must be in USD currency payable to: Institut Teknologi Brunei.
Registration
confirmation/ receipt and further information will be e-mailed to participants. You may use this account detail for your reference when you
make your payment:
Account Name
Account No.
Bank
Bank Address
Swift Code
: Institut Teknologi Brunei
: 00-001-01-0045184
: Bank Islam Brunei Darussalam
: Lot 159, Jalan Pemancha, Bandar Seri Begawan BS8711, Negara Brunei Darussalam
: BIBDBNBB
Full payment must be received before registration is processed and participants must email a scanned copy of the bank
slip or bank advice of telegraphic transfers form to the Secretariat. Participants are responsible for retaining this copy
and must bring it as proof of payment on the first day of the conference.