SEMINAR ANTARABANGSA PSIKOLINGUISTIK III
INTERNATIONAL SEMINAR ON PSYCHOLINGUISTICS III
(SEAPSIL III)
Borang Pendaftaran/Registration Form
Sila tanda yang mana berkaitan/Please tick whichever is applicable
A. SEAPSIL III ( ) Diet: Vegetarian ( )
B. Lagu Nostalgia ( ) Diet: Non-vegetarian ( )
C. Foto Klik ( )
1. Nama Peserta:_________________________________________________________________
Name of Participant_____________________________________________________________
______________________________________________________________________________
2. Alamat:_______________________________________________________________________
Address:________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
3. No. Tel:___________________________________
Tel. No.
4. Alamat E-mel:_______________________________
E-mail Address
5. Maklumat Bayaran: Bank In ( ) Postal Order ( ) Bank Draft ( )
Payment Information
6. Nombor Siri Slip Pembayaran:_____________________________________
Payment Slip Serial Number
7. Jumlah in RM/USD:_____________________________
Amount in RM/USD
Tandatangan Individu/Ketua Kumpulan
Individual Signature/Group Leader
_______________
Name:________________________
Tarikh/Date:__________
Name:________________________
Tarikh/Date:__________
Cara Pembayaran:
Payment Mode
1. Pembayaran dengan cek tidak diterima.
Payment by cheque is not accepted.
2. Peserta dari luar Malaysia perlu menggunakan Bank Draf.
Participants outside Malaysia need to use Bank Draft.
Terima kasih atas sokongan anda.
Thank you for your support.
[/] Saya/kami bersetuju bahawa saya/kami tidak berhak membuat sebarang tuntutan/dakwaan dengan apa-apa cara sekalipun bersabit dengan menghadiri seminar tersebut di atas. (I/we agree that I/we are not entitled to make any claim/indictment in any manner whatsoever pertaining to attending the aforesaid seminar).
