Conference Registration Form

Text Box: 5th Annual Asian Business Research Conference 

 

 

      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

 SECTION 1: CONTACT INFORMATION 

TITLE:

  Mr           Mrs           Miss            Ms           Dr           Prof.           Other, specify:

FIRST NAME:

 

LAST NAME:

 

ADDRESS:

 

MAIN TELEPHONE:

 

 

 

WORK TELEPHONE (if different)

 

 

 

HOME TELEPHONE

 

TOWN/CITY:

 

 

MOBILE PHONE:

 

POST CODE;

 

PRIMARY EMAIL:

 

COUNTRY;

 

SECONDARY EMAIL:

 

FACULTY/DEPARTMENT/SCHOOL:                                                                                                         

 

AFFILIATION (NAME OF UNIVERSITY/INSTITUTE):

 

BROAD FIELD OF RESEARCH

(eg. Banking, Management, etc):

 

Are you willing to serve as a session chair:                           

  Yes           No          

Are you willing to work as a reviewer:             

Yes           No 

How did you hear about this conference?

  Direct Email           Websites (Please Specify) :         

  Other (Please Specify) :  

           

 SECTION 2: PAPER PRESENTATION  

Are you presenting a paper or participating as an observer?                           

   Presenting Paper  

   Observer          

If you are presenting a paper, how many are you presenting?             

 1            2

Please provide the paper number(s) assigned to you in the acceptance letter(s):                           

 

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

 

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

 

 

 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:

 

Description:

 

Amount:

USD $

Credit Card 

International Transfer

Paypal 

Type of Card:   Mastercard     Visa     

Pay to: World Business Institute Limited

Pay to: njahanwbi@gmail.com (for Paypal account Holders)

Name on Card:

Account No: 382353    |   BSB: 033609

OR

Card Number:

Swift Code: WPACAU2S 

Email: Nuha Jahan via njahanwbi@gmail.com

Expiry Date:

Bank Name: Westpac Banking Corporation

For non Paypal account holders for an invoice to be emailed to you

PLEASE NOTE: The Credit Card will be processed by Business Care Australia Pty Ltd, Australia

Address: 37 High Street, Berwick, Melbourne, Victoria 3806, Australia  

 

               

Declaration: I HEREBY DECLARE THAT THE ABOVE INFORMATION ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.

SIGNED:

(or write name here)

 

DATE:

 

PLEASE NOTE: Receipts will be provided on the conference registration day (23 December 2011) unless urgently required.

                       update: 30-07-2011