Group Registration Special Group Registration Conference Group Registration Form Part 1: PACKAGE & REGISTRATION FEEChoose Your Package & CategoryChoose Your Package - Select -ConferenceRegistration Category - Select -Special Group DiscountPreviousNextPart 2: PARTICIPANT PARTICULARSFill the information required belowParticipant InformationFill in the information.Title - Select -ProfDrMrMsName Last Name Job Title/Designation Department/division Company/Organization/University AddressAddress Line 1 City State Zip Code Country Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweTel Mobile No. Email Alternative email address Dietary Requirements Non-vegetarian Vegetarian Allergy (Peanut/Dairy/Seafood/etc.)Special Requirements None DisabledPreviousNextPart 3: PAYMENTChoose Payment MethodChoose Your Category Of Participant (Special Group) Non Presenter No payment items has been selected yetChoose Your Payment Method - Select -InternationalLocal Transferpurchase order/HRDF SBL Khas SchemeChoose Payment Method Pay with Card (Stripe) Pay with PayPalPay with Card (Stripe)Electronic funds transfer Account Name: Human Factors and Ergonomics Society (M) (make transfer in this account name)Account No: 564717004441The swift code for Maybank: MBBEMYKL Account Bank and Address: Malayan Banking Berhad, No. 5 Departure Hall Level 1 KL City Air Terminal (KLCAT), KL Sentral, 50470 Kuala Lumpur, Malaysia Note:- Email a copy of the payment slips to admin@hfemc2023.org. Bank draft/local cheque (for Malaysian only) Name of Account: Human Factors and Ergonomics Society (M) (make bank draft/cheque payable in this account name) Note:1.For bank draft, request for clearing at a local bank in Kuala Lumpur, Malaysia. Attach a copy of the registration form with the bank draft/cheque. Send payment and form to: Human Factors and Ergonomics Society (M) Address: Level 3 & 4, Wisma Suria, Jalan Teknokrat 6, Cyber 5, 63000 Cyberjaya, Selangor, MALAYSIA.Proof Of Payment Slip Choose File PreviousNextPart 4: Terms & ConditionsRead The Agreement Below.Workshop fees are in Malaysian Ringgit and are due in full at Registration on August 14, 2023. Cancellations • All cancellations must be made in writing and email to HFEM email address: secretariat@hfem.org• Cancellations received more than 30 days before the event start date are eligible for refund with a deduction of MYR100 as processing fee. • Cancellations received within 30 days of event start date are eligible for refund with a deduction of MYR150 as processing fee. • Cancellations received within 10 days of event start date are not subject to any refund. • Cancellation of paper that has been published in the proceedings will incur a cost of MYR100 publication fee. I agree to be bound by the Terms & Conditions of the HFEMC 2023. If you do NOT receive a confirmation within 48 hours of your registration, please call +603 8314 3360. I agree to be bound by the Terms & Conditions of the HFEMC 2023. If you do NOT receive a confirmation within 48 hours of your registration, please call Previous Purchase
