REGISTRATION FORM
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SECTION 1: PERSONAL DETAIL
NAME *
GENDER *
INSTITUTION *
FACULTY/DEPARTMENT
RESEARCH FIELD
TYPE OF USER *
SECTION 2: CONTACT DETAIL
ADDRESS *
EMAIL *
CONTACT NO. *
SECTION 3: PAYMENT DETAIL
Note:

- Please send a copy of your bank-in slip/remittance advice/transfer advice to:
urcsecretariat@nilai.edu.my

- Remember to indicate your NAME in the bank-in slip.
PAYMENT RECEIPT NO. *
DATE OF PAYMENT *
MM
/
DD
/
YYYY
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