Club Membership Form Template s3

World Business and Social Science Research Conference

Date: 18 – 19 December 2017 | Venue: Ambassador Hotel, Bangkok, Thailand Conference Registration Form

All participants are required to complete this registration form and return in MS Word format to Ms. Nuha Jahan via [email protected] Fax to: +61 3 9702 0122 by 20 November 2017.

SECTION 1: CONTACT INFORMATION

TITLE: Mr Mrs Miss Ms Dr Prof. Other, specify: FIRST NAME: LAST NAME:

ADDRESS: MAIN TELEPHONE: WORK TELEPHONE (if HOME TELEPHONE TOWN/CITY: MOBILE PHONE:

POST CODE; PRIMARY EMAIL:

COUNTRY; SECONDARY EMAIL: FACULTY/DEPARTMENT/SCHOO L: AFFILIATION (NAME OF UNIVERSITY/INSTITUTE): BROAD FIELD OF RESEARCH (eg. Banking, Management, etc): Are you willing to serve as a Are you willing to work Yes No Yes No session chair: as a reviewer: How did you hear about this Direct Email Websites (Please Specify) : conference? Other (Please Specify) :

SECTION 2: PAPER PRESENTATION

Are you presenting a paper Presenting Paper If you are presenting or participating as an Observer ONLY a paper, how many 1 2 observer? Publication ONLY are you presenting? Yes No Please provide the paper Do you have a If Yes- which number(s) assigned to you preference for paper date: in the acceptance letter(s): presentation date? 18 Dec 19 Would you like your paper to Yes No be included in the online refereed conference If Yes- Please choose what you would like to upload to the proceedings? Abstract Full Paper

SECTION 3: PAYMENT INFORMATION

Please indicate which code and description you are paying for (refer to the fee schedule) and tick the payment option you choose to pay by. For credit card payments, please fill in all relevant information below.

Code: Descriptio Amoun USD $ n: t: Credit Card International Transfer Paypal Mastercard Pay to: [email protected] (for Type of Card: Pay to: Business Care Australia Pty Ltd Visa Paypal account Holders) Branch No: 033090 | Account No. OR Name on Card: 220699 Email: Nuha Jahan via Card Number: Swift Code: WPACAU2S [email protected] Bank Name: Westpac Banking For non Paypal account holders for Expiry Date: Corporation an invoice to be emailed to you PLEASE NOTE: The Credit Western Union Address:: 302 Clayton Road, Card will be processed by Please Quote MTCN: Clayton 3168, Victoria 3806, Australia Business Care Australia Pty

Ltd, Australia Money Gram Please Quote Ref. No: Declaration: I agree that I cannot claim back the registration fee I paid under any circumstance.

SIGNED: (or write name DATE: here) PLEASE NOTE: Receipts will be provided on the conference registration day (18 December 2017) unless urgently required.