Registration for Consumers in the Information Society 2012

Organisation details

Organisation name:

If you would not be attending for an organisation, leave blank.

Address: *

Country:

Office phone: +

Please include country code if outside Malaysia. Spaces and separators are permissible.

Office fax: +

Personal details

Title: *

Family name: *

First name:

Position:

Your position within the organisation, eg. Project Manager or Head of Campaigns.

Mobile phone: +

Please carry this phone with you on your trip so that we can contact you in an emergency.

Email address: *

Confirmation of your registration will be sent by email only.

Special requirements

Meal requirements:

Please include any details not covered above (eg. no onion or garlic, specific allergies) in the comments section below.

Preferred language:

English

Français

Español

Translation may be provided in these languages, if sufficient demand exists.

Disabilities:

Travel details

Please only complete this section if you will be travelling from outside Malaysia to attend the meeting.

Date of check-in:

Please check available flights and estimate your desired check-in date.

Date of check-out:

Do you require a letter to obtain a visa?

Yes

Do you require a hotel room to be reserved for you?

Yes

The booking will be at your own expense, at the hotel rate of approximately USD$80 per night. Please note that no financial assistance is available from CI for any expenses whatsoever.

Comments:

If you have any special requests or comments, please enter them here.

Payment: *

Yes

I agree to pay the conference registration fee of USD$100 (or RM300) in cash upon registration at the venue.

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Registration for Consumers in the Information Society 2012

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