1. SGGS INTERNATIONAL STUDENTS’ CONFERENCE 2010
UNIVERSITI SAINS MALAYSIA,
PENANG, MALAYSIA
13TH – 16TH JUNE 2010
REGISTRATION FORM
Please complete the Registration Form and send to the Conference Coordinator by post/fax or
email before or by 13 May 2010.
Postal Address:
The Coordinator
SGGS International Students’ Conference 2010
SMK(P) St George,
Macalister Road
10450 Penang
Malaysia
Fax No: 60-42295886 (Attn: Conference Coordinator)
Email Address: sggsconference2010@gmail.com to the Conference Coordinator
 Please note that all correspondence regarding the conference will be by email if possible
AND updates regarding the conference will be available on our website
www.smkpstgeorge.edu.my
A. PARTICULARS OF SCHOOL (Please type or print clearly in CAPITAL LETTERS)
1. Name of School: ____________________________________________________
2. Name of Headmaster/Headmistress: __________________________________
3. Postal Address:
________________________________________________________
________________________________________________________
________________________________________________________
4. Telephone No: ____________________
5. Handphone No. ____________________
6. Fax No: ____________________
7. Email Address: ____________________
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2. B. PARTICULARS OF DELEGATES
Student Delegate 1:
1. Name: ___________________________________ 2. Sex: ___________
3. Age: ____________ 4. I/C or Passport No.: ___________
5. Name for conference name tag: ________________________________________
6. Special Diet (such as vegetarian meals or meals without beef): _________________
(Please note that all meals served are halal.)
7. Special Requirements
(such as for wheel chair users, blind or visually impaired persons and others):
______________________________________________________________________
Student Delegate 2:
1. Name: ___________________________________ 2. Sex: ___________
3. Age: ____________ 4. I/C or Passport No.: ___________
5. Name for conference name tag: ________________________________________
6. Special Diet (such as vegetarian meals or meals without beef): _________________
(Please note that all meals served are halal.)
7. Special Requirements
(such as for wheel chair users, blind or visually impaired persons and others):
______________________________________________________________________
Student Delegate 3:
1. Name: ___________________________________ 2. Sex: ___________
3. Age: ____________ 4. I/C or Passport No.: ___________
5. Name for conference name tag: ________________________________________
6. Special Diet (such as vegetarian meals or meals without beef): _________________
(Please note that all meals served are halal.)
7. Special Requirements
(such as for wheel chair users, blind or visually impaired persons and others):
______________________________________________________________________
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3. Teacher Escort:
1. Name: ___________________________________ 2. Sex: ___________
3. Age: ____________ 4. I/C or Passport No.: ___________
5. Name for conference name tag: ________________________________________
6. Special Diet (such as vegetarian meals or meals without beef): _________________
(Please note that all meals served are halal.)
7. Special Requirements
(such as for wheel chair users, blind or visually impaired persons and others):
______________________________________________________________________
C. REGISTRATION DETAILS: (Please tick the appropriate box.)
Type of Registration Participants from local or overseas schools Total
USD80 X …… (no. of delegates) USD ……
Registration A
EUR60 X …… (no. of delegates) EUR ……
(before 13 April, 2010)
RM250 X …… (no. of delegates) RM ……
USD90 X …… (no. of delegates) USD ……
Registration B EUR70 X …… (no. of delegates) EUR ……
(after 13 April, 2010)
RM300 X …… (no. of delegates) RM ……
Grand Total
Only registration forms with payment will be accepted and registered.
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4. B. PAYMENT METHOD: (Please tick the appropriate box.)
BANK DETAILS:
Name of the account: SEK MEN PEREMPUAN ST GEORGE
A/C No.: 007068302002
Name of Bank: Maybank Pulau Tikus, Penang, Malaysia
Payment into Bank Account directly
Date of payment ______________________
(Please send a clear legible photocopy of the stamped bank pay-in slip as proof
of payment along with your registration form.)
Bank Draft
Bank Draft No. ______________________
Date of Bank Draft: ______________________
Amount: ______________________
Date of Despatch: ______________________
Electronic Transfer
Date of Transfer: ______________________
Amount Transferred: ______________________
Reference Number, if any; ______________________
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5. C. STUDENT PARTICIPATION
All students are encouraged to take an active part at the conference by being one of the
following so as to benefit most from the conference:
(Please tick the appropriate box.)
Chairperson
(To chair the keynote address, plenary sessions, workshops or concurrent sessions)
Name(s): ___________________________________________________
Rapporteur
(To record the proceedings of the keynote address, plenary sessions, workshops or
concurrent sessions)
Name(s): ___________________________________________________
Respondent
(To respond to the paper presentation of the keynote speaker or plenary session speaker)
Name(s): ___________________________________________________
Presenter of Free Papers
(Please take note of the closing date for abstract submission)
Name(s): ___________________________________________________
** As the response to the above may exceed the needs of the conference, the organisers will
have to make a final selection and delegates will be informed in due course of the role that
they have at the conference. Presenters of Free Papers will be duly informed whether their
papers are accepted for presentation.
Thank you very much and we look forward to seeing you at the conference.
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