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Date:
23-24 December, 2011 | Venue: BIAM, 63 New Eskaton, Dhaka, Bangladesh
Conference Registration Form
All
participants are required to complete this registration form and return
in MS Word format to Ms. Nuha Jahan via
uspapcon@gmail.com
or Fax to: +61 3 9702
0122
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1: CONTACT INFORMATION
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TITLE: |
Mr
Mrs
Miss
Ms
Dr
Prof.
Other, specify: |
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FIRST NAME: |
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LAST NAME: |
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ADDRESS: |
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MAIN TELEPHONE: |
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WORK TELEPHONE (if different) |
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HOME TELEPHONE |
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TOWN/CITY: |
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MOBILE PHONE: |
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POST CODE; |
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PRIMARY EMAIL: |
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COUNTRY; |
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SECONDARY EMAIL: |
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FACULTY/DEPARTMENT/SCHOOL:
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AFFILIATION (NAME OF UNIVERSITY/INSTITUTE): |
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BROAD FIELD OF RESEARCH
(eg. Banking, Management, etc): |
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Are you willing to serve as a session
chair: |
Yes
No |
Are you willing to work as a reviewer: |
Yes
No |
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How did you hear about this conference? |
Direct Email
Websites (Please Specify) :
Other (Please Specify) : |
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SECTION
2: PAPER PRESENTATION
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Are you presenting a paper or participating as an
observer? |
Presenting Paper
Observer
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If you are presenting a paper, how many are you
presenting? |
1
2 |
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Please provide the paper number(s) assigned to you in the acceptance
letter(s): |
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Do you have a preference for paper presentation date?
(Please note we may not be able to guarantee such preference) |
Yes
No
If Yes- which date:
23 Dec
24 Dec
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Would you like your paper to be included in the online refereed
conference proceedings? |
Yes
No
If Yes- Please choose what you would like to upload to the proceedings
Abstract
Full Paper
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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.
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Code: |
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Description: |
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Amount: |
USD $ |
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Credit Card
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International Transfer
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Paypal
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Type of Card:
Mastercard
Visa |
Pay to:
World Business Institute Limited |
Pay to:
njahanwbi@gmail.com (for Paypal account Holders) |
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Name on Card: |
Account No:
382353 |
BSB:
033609 |
OR |
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Card Number: |
Swift Code:
WPACAU2S |
Email:
Nuha Jahan via
njahanwbi@gmail.com |
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Expiry Date: |
Bank Name:
Westpac Banking Corporation |
For non Paypal account holders for an invoice to be emailed to you |
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PLEASE NOTE: The Credit Card will be processed by
Business Care Australia Pty Ltd, Australia |
Address:
37 High Street, Berwick, Melbourne, Victoria 3806, Australia |
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Declaration:
I HEREBY DECLARE THAT THE ABOVE INFORMATION ARE TRUE AND ACCURATE TO
THE BEST OF MY KNOWLEDGE. |
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SIGNED:
(or write name here) |
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DATE: |
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PLEASE NOTE:
Receipts will be provided on the conference registration day (23 December 2011) unless urgently required. |