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UTAR Centre for Biodiversity Research (CBR) Membership Application Form
Membership status *
Please indicate whether this application is an existing or a new one.
Year joined *
If you are an existing member, please indicate which year you joined. For new application, please state the current year joined.
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Name *
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UTAR Staff Number *
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Designation *
Faculty *
Department *
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E-mail address *
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Phone number (Office) *
Please include your extension number.
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Phone number (Mobile)
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Highest education obtained *
University and specialisation *
Please indicate the university/institute of higher education where you obtained your highest education and the field of study. E.g. University Malaya, Zoology
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Research interest(s) *
Please include a list and short description(s)/objective(s) of your research interests. E.g. 1. Chemopreventive properties of natural products from Malaysian forests. To study the anti-proliferative effects of natural product compounds isolated from plants of the Malaysian forest.
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Research interest(s) keywords *
Please indicate up to 7 keywords to indicate your research interest(s). Please use short phrases, separated by semicolons. E.g. natural products; cancer biology;
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CBR Research Cluster *
Please indicate the most relevant research cluster which best fits your research interest(s). You may choose more than one.
Required
Compliance to Personal Data Protection Act 2010 (“PDPA”) *
Please be informed that in accordance with Personal Data Protection Act 2010 (“PDPA”) which came into force on 15 November 2013, Universiti Tunku Abdul Rahman (“UTAR”) is hereby bound to make notice and require consent in relation to collection, recording, storage, usage and retention of personal information. The said form is also available for download from IPSR website and research portal. Link to download the Personal Data Protection Statement form => http://research.utar.edu.my/PDPA%20Statement%20form.doc. By ticking the checkbox below, you hereby authorise and consent to us processing (including disclosing) your personal data and any updates of your information, for the purposes and/or for any other purposes related to the purpose. If you do not consent or subsequently withdraw your consent to the processing and disclosure of your personal data, UTAR will not be able to fulfill our obligations or to contact you or to assist you in respect of the purposes and/or for any other purposes related to the purpose.
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