Regular Presenter Payment Form
PLEASE READ THE FOLLOWING INFORMATION AND INSTRUCTIONS CAREFULLY BEFORE COMPLETING THE FORM.

1. This form is to be completed by the main author and co-author(s) (if relevant) who will to attend the 65th TEFLIN International Conference and deliver their presentation (lecture/round table, workshop, poster) in the parallel sessions at the conference.

2. If both the main author and co-author(s) will attend the conference, they must register and complete the form separately.

3. Be sure to make the payment first, and then take a photograph or screenshot of the payment evidence (receipt). This form requires the payer to upload the file of the payment evidence.

4. The Organising Committee (OC) apologises that it cannot accept payment by credit cards. However, credit card owners should contact the OC for further information about other payment methods.

5. TEFLIN members who own their valid individual membership cards are required to upload a photograph or electronic copy of the cards.

6. Please be advised that TEFLIN Institutional Membership cards, which apply to universities, faculties, departments, etc., will not be accepted for individual presenters' registration/payment.

7. Should you have any difficulties or questions about registration, please contact the Organising Committee by email at teflin652018@unm.ac.id or by phone/WhatsApp: +62 813 539 888 45.

Email address *
Personal Information
1. Name (as it will appear on certificate) *
2. Institution / School *
3. Phone number *
4. Presentation title
5. Nationality *
6. If you are Indonesian, which province do you live and work in?
7. How did you first hear about the 65th TEFLIN International Conference 2018?
8. Paying as/for (tick where applicable) *
Required
If you are a registered TEFLIN member, click here to upload an image of your ID card ( max 1 MB )
PAYMENT INSTRUCTIONS
1. Please make your payment via electronic transfer to:
Bank: Bank Mandiri
Branch: KCP Sungguminasa, Gowa, Sulawesi Selatan
Account number: 174-00-0089204-2
Account holder: Amra Ariyani.TEFLIN
Swift Code: BMRIIDJA
Payer’s name (if different from above)
2. Scan or photograph your transfer receipt and upload the file here (pdf or image file, max 1 MB)
*
Required
A copy of your responses will be emailed to the address you provided.
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