3ANS2013 Registration

Please fill out the form to register for the 3rd Annual Neuroscience Seminar 2013. When you register for Day 1 programme, you are automatically registered for all Day 2 programme except for competitions and guided activities that required onsite registrations.

Asteriks (*) denote mandatory fields. You shall receive a confirmation email with an Unique ID from our secretariat within 3 working days. Please use the unique ID for all your future enquiries regarding the registration.

(1) Name: *
(2) Current position: *
(3) Gender: * Male Female
(4) Designation: *
(5) Email Address: *
(6) Affiliation and address: *
(7) Type of Registration: * Registration - Professional (RM100.00) Registration - Students / Support Staff (RM20.00)
Your supervisor's name (if you are a student/support staff):
Your supervisor's email (if you are a student/support staff):
(8) Method of payment: * Via a local cheque payable to "Bendahari, UPM" Via fund transfer to UPM CIMB Bank Account Via an internal fund transfer (for UPM participants only) - MUST complete the following information:
Please refer to the method of payment here.
(For internal transfer only) Vot Number:
(For internal transfer only) Owner of the Vot:
(9) Meal preferences: * Non-vegetarian Vegetarian
(10) Please initial here to confirm your registration: *
By placing your initial here you agree to ensure that all the necessary payments are made before the seminar.

~NEUROSCIENCE~ for everyday life

June 11-12, 2013 at FMHS, UPM