INTERVARSITY INVESTMENT CHALLENGE 2011 REGISTRATION FORM
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COMPANY NAME
COMPANY NAME *
Company Name/Group Name
GROUP LEADER
NAME *
IDENTITY CARD NO / PASSPORT NO *
(e.g: 123456-78-9999)
PREFERRED NAME ON IVIC TAG *
STUDENT IDENTITY CARD NO *
UNIVERSITY/COLLEGE *
COURSE *
CONTACT NO(MOBILE) *
(e.g:010-1234567)
EMAIL ADDRESS *
DO YOU REQUIRE VEGETERIAN MEALS? *
PLEASE STATE IF YOU HAVE ANY ALLERGY.
PLEASE STATE IF YOU HAVE ANY HEALTH PROBLEM.
GROUP MEMBER #1
NAME *
IDENTITY CARD NO / PASSPORT NO *
(e.g: 123456-78-9999)
PREFERRED NAME ON IVIC TAG *
STUDENT IDENTITY CARD NO *
UNIVERSITY/COLLEGE *
COURSE *
CONTACT NO(MOBILE) *
(e.g:010-1234567)
EMAIL ADDRESS *
DO YOU REQUIRE VEGETERIAN MEALS? *
PLEASE STATE IF YOU HAVE ANY ALLERGY.
PLEASE STATE IF YOU HAVE ANY HEALTH PROBLEM.
GROUP MEMBER #2
NAME *
IDENTITY CARD NO / PASSPORT NO *
(e.g: 123456-78-9999)
PREFERRED NAME ON IVIC TAG *
STUDENT IDENTITY CARD NO *
UNIVERSITY/COLLEGE *
COURSE *
CONTACT NO(MOBILE) *
(e.g:010-1234567)
EMAIL ADDRESS *
DO YOU REQUIRE VEGETERIAN MEALS? *
PLEASE STATE IF YOU HAVE ANY ALLERGY.
PLEASE STATE IF YOU HAVE ANY HEALTH PROBLEM.
GROUP MEMBER #3
NAME
IDENTITY CARD NO / PASSPORT NO
(e.g: 123456-78-9999)
PREFERRED NAME ON IVIC TAG
STUDENT IDENTITY CARD NO
UNIVERSITY/COLLEGE
COURSE
CONTACT NO(MOBILE)
(e.g:010-1234567)
EMAIL ADDRESS
DO YOU REQUIRE VEGETERIAN MEALS?
Clear selection
PLEASE STATE IF YOU HAVE ANY ALLERGY.
PLEASE STATE IF YOU HAVE ANY HEALTH PROBLEM.
GROUP MEMBER #4
NAME
IDENTITY CARD NO / PASSPORT NO
(e.g: 123456-78-9999)
PREFERRED NAME ON IVIC TAG
STUDENT IDENTITY CARD NO
UNIVERSITY/COLLEGE
COURSE
CONTACT NO(MOBILE)
(e.g:010-1234567)
EMAIL ADDRESS
DO YOU REQUIRE VEGETERIAN MEALS?
Clear selection
PLEASE STATE IF YOU HAVE ANY ALLERGY.
PLEASE STATE IF YOU HAVE ANY HEALTH PROBLEM.
NOTE
A verification email will be sent to you to inform your eligibility to participate.
After receiving the verification email, kindly proceed to pay the registration fee of RM50 to Yong/Chin, bank account number 1440-0107151-52-0 (CIMB) before 30 November 2011.
Please scan the bank slip and email it to ivic2011.um@gmail.com as prove of payment.
Resume of each group member also will have to be submitted by emailing it to ivic2011.um@gmail.com before 30 November 2011.
Thank you for registering for IVIC 2011. We hope to see you soon.

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