Registration Form - 26th Nov 2016 Symposium

Managing Students with Reading Difficulties
A One-Day Symposium on Reading 26th November 2016, Hatten Hotel Melaka
- a collaborative project of the Reading Specialists Association Singapore and Inclusive Education Symposium Melaka

REGISTRATION FORM
Places limited to ONLY 100 participants! Please register early...

Registrant Information

Title: ____________________________
Birth Date:________________________

Home Phone:______________________
Occupation:_______________________

First Name:________________________

Last Name:________________________

Email Address:_________________________________________________________
Work / Mobile Phone:____________________________________________________
Organisation:___________________________________________________________

Address Information:

Street Address Line :_____________________________________________________

                                  _____________________________________________________
State           Zip Code

Symposium Fee

• Rate inclusive of lunch and 2 tea-breaks
• Please tick the appropriate box

Malaysian participant

Remark:
Payment Method

  Online Transfer / Cash Deposit
  Cheque or Bank Draft

  Local Order (LO/PO)

Note:

International participant
(Singapore, Macau, other)

                             SGD 60
Please tick if VEGETARIAN is required for lunch and tea-breaks [__]

 Early Bird
(by 15 Nov 2016)

RM 100

 Late Registration
(after 15 Nov 2016)

RM 120 SGD 80

- Please email a copy of scanned bank-in slip and registration form to: <iesymposium2015@gmail.com>

**Registration and payment will be confirmed by email. Receipt will be issued on day of registration. 
**Payment received is not refundable and cancellation is not allowed.

 For Office Use

Date received:______________________________________

Registration Form No:_________________________________

Bank-in Slip:________________________________________
Receipt No:_________________________________________

* Hong Leong Bank Berhad
*(Account No.: 02601-011393)
*Account Name: IE Symposium

Payable to IE Symposium Cheque No:____________________________________

 Bank Draft No.___________________________
 Bank:___________________________________

 Reference No:____________________________ 

Terms and Conditions

- No refunds for non-attendance.

- Participation in this Symposium will only be confirmed upon receipt of
  completed registration form and full payment.

Privacy Statement

USE OF PERSONAL INFORMATION

The Symposium will collect and store information you provide in this
Registration Form for the purposes of:
- registering your attendance at the Symposium;
- assisting with administrative and planning purposes;

- planning and developing future events; and
- facilitating your requirements in relation to the Symposium.

PHOTOGRAPHY DISCLAIMER

By attending the Symposium, you acknowledge that photographs &/or videos
of you may be taken by the Symposium officials &/or reporters at any
time. Furthermore you grant the Symposium organisers permission to use
photographs &/or videos of your likeness in any type of media, including
website and print publications, without compensation &/or reward.

Additional Information

Participants who need overnight accommodation will need to make their own
reservations.

- Hatten Hotel is offering a discounted rate for participants attending
  the Reading Symposium (call reservation and mention that you are
  attending the Reading Symposium).