25-26 Nov 2017 Symposium/Colloquium Registration Form
Working with Students with Learning and Behavioral Challenges

25th November 2017 (Saturday, 8.30am to 5.30pm) - Symposium
26th November 2017 (Sunday, 8.30am to 1.00pm) - Colloquium

Oriental Melaka Straits Medical Centre
Pusat Perubatan Klebang, 75200 Malacca, Malaysia
Website: <http://orientalmedical.com.my/>

Contact us at +6012 301 5123 or iesymposium2015@gmail.com

Email address *
Participant information
Designation *
First name *
Your answer
Last name *
Your answer
Email *
Your answer
Contact number *
Your answer
Organization *
Your answer
Occupation *
Your answer
Dietary restrictions *
Conference fees
Please select the event you wish to attend below.

Note: You will receive an e-mail confirmation upon receipt of your completed registration and payment.

1) Symposium (limited to 120 participants only)
Fee inclusive of conference materials, certificate of participation^ and meals (1 lunch and 2 tea breaks).

^By completing this event, the participant is entitled for 3 CEUs.

2) Colloquium (limited to 40 participants only)
Fee inclusive of certificate of participation^ and 1 tea break (lunch is NOT included).

^By completing the event, the participant is entitled for 2 CEUs.

Payment details
1) For Malaysian participants, please make fee (RM) payable to:
Bank: Hong Leong Bank Berhad
Beneficiary name: IE Symposium
Account number: 02601011393

2) For Oversea participant, please make fee (SGD) payable to:
Bank: OCBC Bank
Beneficiary name: Lee Ban Meng
Account number: 511337156001
Bank code: 7339
Bank address: 23 Serangoon Central, #B2-28/29, Singapore 556083
Bank branch code: 511
Swift code: OCBCSGSG

*Please email the proof of transaction to: iesymposium2015@gmail.com

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