MULTIPLE INTELLIGENCE WORKSHOP
BRAIN IMPROVISATION & STIMULATION
REGISTRATION FORM
Date : 10th February 2018
Time : 8.30am-4.30pm
Venue : Auditorium Jurutera (Radin Umar), Fakulti Kejuruteraan UPM
Fees : RM120 (Individu)
RM100 (Group - above 5)
Please make payment to the stated account
and attached the prove of payment with this form
Bank : CIMB Bank
Acc Holder : Smart IQ Power Integration
Acc No : 8602007708
Name
IC No / My Kid No
INDIVIDUAL REGISTRATION
Phone
Email
Address :
Occupation (MIW) :
Employer / School :
Prove of payment : Please stated reference as MIW (IC No) / BIS (My Kid) Eg (MIW 770707071234) (BIS 070707075678)
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GROUP REGISTRATION
No of MIW participants :
MIW Participants Name & IC No :
No of BIS participants :
BIS Participants Name & My Kid / IC No :
HP No :
Email :
No of participants : For group registration please stated the number of participants to register
Prove of payment : Please stated reference as MIW (IC No) / BIS (My Kid) Eg (MIW 770707071234) (BIS 070707075678)
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REGISTER