Symposium & Short Course

Registration Type *

PARTICIPANT

PRESENTER

Personal Details

Full Name *

Membership No.

IC/Passport No. *

Telephone No. *

Email Address *

(Registration details will be send to this email address)

Address *

Address

City

State/Province

Zip/Postal

Country

Payment Details

Note: Payment can be made by direct bank transfer the amount to our bank details stated below. All registration will be processed once the proof of payment has been received.

Bank name :	RHB ISLAMIC BANK BERHAD
Account name :	PERSATUAN KEJURUTERAAN GEOLOGI DAN MEKANIK BATUAN MALAYSIA
Account number :	21245760018819
Branch name :	BANDAR BARU BANGI, SELANGOR

Symposium *

SEGRM MEMBER (RM200.00)

NON-MEMBER (RM350.00)

STUDENT (RM100.00)

NOT ATTEND

SCOPUS Publication *

YES (RM400.00)

Short Course *

SEGRM MEMBER (RM500.00)

NON-MEMBER (RM700.00)

NOT ATTEND

Total Payment (RM) *

Submission

Declaration *

I hereby declare that the details furnished above are true and correct to the best of my knowledge. I shall inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.