GPLE Registration Form
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Korea, 15-20 August 2012 Registration Form Please send form by email to [email protected] or by fax: 03-7886-2103 Personal Information: (PLEASE PRINT CLEARLY) Gender: M F Legal or Passport Name: Title (Mr., Ms., Dr., etc.) First (Given) Middle Last (Family) Name as preferred on conference badge: No more than 20 characters. Include honorific eg. Ven., Dr., Tan Sri, Dato’, Mr., Ms. Organization: Position or Job Title: Mailing Address: City: State: Postal Code: Country: Office Phone: Fax: Email: Mobile phone: Special Dietary Requirements: Next of Kin/ Emergency: Contact Person: Phone: Email: Other contact information: Do you have any medical conditions we should be aware of: Completion of this registration form indicates that you have read, understood and agree to comply with the Global Peace Leadership Exchange Registration Policies. Participant Signature: Date:
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Come join this unique program to experience something you never do on your own in Korea. Be a peacemaker and experience!
Transcript of GPLE Registration Form
Korea, 15-20 August 2012
Registration Form
Please send form by email to [email protected] or by fax: 03-7886-2103
Personal Information: (PLEASE PRINT CLEARLY) Gender: M F Legal or Passport Name:
Title (Mr., Ms., Dr., etc.) First (Given) Middle Last (Family) Name as preferred on conference badge:
No more than 20 characters. Include honorific eg. Ven., Dr., Tan Sri, Dato’, Mr., Ms.
Organization:
Position or Job Title:
Mailing Address:
City:
State:
Postal Code:
Country:
Office Phone:
Fax:
Email:
Mobile phone:
Special Dietary Requirements:
Next of Kin/ Emergency: Contact Person:
Phone:
Email:
Other contact information:
Do you have any medical conditions we should be aware of:
Completion of this registration form indicates that you have read, understood and agree to comply with the Global Peace Leadership Exchange Registration Policies. Participant Signature:
Date:
Flight Itinery: Arrival Date:
Flight No:
Arrival Time:
Departure Date:
Flight No:
Departure Time:
Registration: I would like to participate in the following: (Please tick) Global Peace Leadership Exchange (15-‐17 August)
This includes:
§ Korean Traditional Hotel – Swiss Hotel (Ondol Style) Check-‐in on August 15, Check-‐out 17
§ Meals from arrival in Korea till Lunch on August 17 § Ground Transportation (Airport pick up till Departure)
200 USD or MYR 645
Global Peace Festival Korea 2012 (17-‐20 August)
This includes: § Double-‐Occupancy Room (check-‐in on August 17, check-‐out on August
20) at Grand Hilton Hotel (depend on availability) § Welcoming Banquet at 7:00 PM on August 17 § Access to all Conference Sessions § Meals from Dinner on August 17 to Breakfast on August 20 § Ground Transportation till Departure on August 20
500 USD
Payment Method of Payment:
1) Global Peace Leadership Exchange - Cash/ Cheque should be made payable to GLOBAL PEACE FESTIVAL MALAYSIA BHD. A/C No. 5123-5231-7503, MAYBANK BERHAD You may also pay by cash in USD to our office.
2) Global Peace Festival 2012 – please pay by USD to our office.
Global Peace Festival (GPF) Malaysia 3A08 Block A, Kelana Centre Point. No 3 Jalan SS7/19, 47301 Kelana Jaya, Petaling Jaya Selangor.
♦Tel: 03-‐7805 4760 ♦Fax: 03-‐7886 2103 ♦ Email: [email protected] ♦Website: globalpeacefestival.org
