APRU-UM Summer Program 2015

‘Developing Future Global Leaders of the Pacific Rim: The Different Facets of Leadership’

2 August – 12 August 2015

University of Malaya, Malaysia

Registration Form

Please send the completed form to by 15th May 2015.

Name of University

Participant Information

Family Name / First Name
Gender (M / F) / Date of Birth (dd-mm-yyyy)
Place of Birth / Email
Telephone
(country code – area code – tel no.)
Mailing Address
Passport Information
Full Name as in Passport / Nationality
Passport No. / Place of Issue
Date of Issue / Date of Expiry
Visa letter required / Yes No
Other Information
Special Dietary Requirements (i.e. vegetarian, halal, etc.)
Flight Details and Period of Stay (for accommodation and airport transfer purposes)
Flight no./Time/Date of Arrival / Flight no./Time/Date of Departure
Check-in Date / Check-out Date
Next-of-Kin (NOK) Should there be a need to contact your next-of-kin during an emergency, the person below will be contacted immediately.
Name / Relationship with Participant
Address
Contacts / (a)  Home tel no.
(country code – area code –tel no.)
(b)  Mobile no.
(country code – mobile no.)
(c)  Email
Official Contact Person at Home University
Name / Email
Telephone
(country code – area code – tel no.) / Fax
(country code – area code – fax no.)
Mailing Address

Fees (Please √ where applicable)

Student from Partner University / USD 450
Optional Tour (Taman Negara Ecotourism,
3 days and 2 nights) / USD 350

Program Withdrawal
Students wishing to withdraw from the program must submit a formal written request to the International Student Centre, University of Malaya. Should the student decide to withdraw from the program, certificate will not be issued. Students also lose their occupancy in the International House and they should return their student ID card.

Refund Policy
Students must submit a written request for refund of the programme fee to International Student Centre, University of Malaya. Additional bank and postage charges will be deducted from the refund amount.

Programme Fee: / By June 15, 2015 / 100% refund
June 16, 2015
or thereafter / No refund

Payment Information

Payment of the registration fee must be paid to University of Malaya no later than 30th May 2015. Please notify Ms. Vigneshree King at once your payment has been completed.


AccountHolderNameandaddress：

Payee : Bursar University of Malaya

Bank Account : 8001279998

Address : CIMB Bank Berhad, University of Malaya Branch, 50603 Kuala Lumpur,

Malaysia

SWIFT Code : CIBBMYKL

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