12th Annual London Business Research Conference

Date: 10 – 11 July 2017 | Venue: Imperial College, London, UK Conference Registration Form

All participants are required to complete this registration form and return in MS Word format to Nuha Jahan via email: [email protected] or Fax to (Australia): +61 3 9702 0122 by 16 June 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 Are you willing to work Yes No (eg. Banking, Management, etc): as a Designated 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 How many papers are or participating as an 1 2 Observer ONLY you presenting? observer or publishing Publication ONLY Please provide the paper Do you have a Yes No number(s) assigned to you preference for paper If Yes- which presentation date? in the acceptance letter(s): date: (please note this cannot be Would you like your paper to Yes No 10 Jul 11 be included in the online refereed conference If Yes- Please choose what you would like to upload to the proceedings of WBI? 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 US $ n: t: Credit Card International Transfer Paypal Mastercard Pay to: [email protected] (for Type of Card: Pay to: World Business Institute Visa Paypal account Holders) Branch No: 033609 | Account No. OR Name on Card: 382353 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 Card will be processed by Address: 27 High Street, Berwick, Please Quote MTCN: World Business Institute, Melbourne, Victoria 3806, Australia Australia **PLEASE MENTION PAPER No. & Money Gram CONFERENCE TITLE IN Please Quote Ref. No: TRANSFER

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 (10 July 2017) unless urgently required.