CSR Conference 2004

Registration form

(This form has to be filled in by all the CSR Conference 2004 delegates and the organizing and Scientific committee members)

Date                        :  21^st, 22^nd & 23^rd November 2004 (Sunday to Tuesday)

Venue & Country                        :  Equatorial Hotel ( 5 Stars ), Penang, Malaysia

Conference series                        :  2^nd International Conference on Corporate Social Responsibility

Conference theme                        :  Stakeholders and Social Responsibility

Organised by                        :  Ansted University Asia Regional Service Center (Ansted Service Center)

Presented and hosted by                        :  CSR Conference 2004 Organising & Scientific Committee

Supported by                        :  Ansted University Foundation

1.  Personal details

Family/Surname/Last name : ____________________________ Given name___________________________

Name to appear on Conference Badge with title : _______________________________________________ Name of Organisation/Institution : ______________________________________________________________

Nature of business activities : _________________________________________________________________

Position held/ Job Title : ________________________________ Department :__________________________

Mailing address : ___________________________________________________________________________

Nationality :______________________ Sex : __________Age :__________Marital Status : ________________

Please use full international telephone and fax numbers providing country code, area code, and number :

Telephone(office) : _____________________(Home) : ___________________(Mobile) : __________________  Fax(Office) : __________________________Email(s) : ____________________________________________

WWW address (company) : _____________________________(personal) : ____________________________

Dietary restrictions (if any) : __________________________________________________________________

Passport No. (Non-Malaysian need to fill in for immigration purpose) : _________________________________

Please print my name as (onto the certificate of attendance) : ________________________________________ 

2.  Please write [ X ] to the relevant place

q    I am one of the [   ] sponsors, [   ] presenters, [   ] Organizing Committee members, [   ] Scientific committee   members 

q    I am willing to serve as a [   ] Conference Master of Ceremony, [   ] Co-Master of Ceremony

q    I am willing to serve as a [   ] facilitator or chair [   ] for parallel sessions or Round Table session 

q    I am a presenter at this conference and I need an [   ] Overhead projector, [   ] Slide Projector, [   ] LCD Projector, [   ] Computer, [   ] Others, please specify_____________________________________________

q    My paper is based on [   ] Completed research,  [    ] Research-supported position paper  [   } On-going research nearing completion 

q    I am [   ] the only author of this paper, This paper has [    ] 2 or [   ] 3 or [    ] 4  or _____ authors

q    I would classify myself as [    ] an expert researcher. [   ] an active researcher, [   ] a beginning/new Researcher,  [   ] keen learner

q    I would like to present my paper at [   ] Symposium [   ] Round Table [    ] Poster Session

  I have attached an abstract to describe my presentation including its purpose, content and format to Organising Committee. Yes/No  (Deadline is on 1^st July 2004)

q    Also I am willing to serve as [   ] volunteer co-ordinator for handling Front desk team, [   ] Administration team, [   ] Programme activity team, [   ] Event team during the event on.

q    I am willing to assist in [   ] marketing and promoting the conference among my network contacts, [   ] helping to get sponsors, [  ] helping to select criteria for the CSR awards, [   ] other, please specify_______________

3.  Accommodation Reservation : Kindly indicate your first, second, and third choice of hotels

[   ]  Hotel Equatorial: Room type: Superior US$60.00++ or Deluxe US$65.00++(inclusive of breakfast) 

[   ]  Hotel Vistana: Room type: Superior US$50.00nett or Suite US$60.00nett (inclusive of breakfast)  

[   ]  Vistana Apartment with two bedrooms US$60.00nett or three bedrooms USD$90.00nett with breakfast

[   ]  Self-arrangement  

[   ]  My accommodation will be sponsored by Ansted Foundation.(See no.5) 

I wish to share a room with___________________________________________________________________

My Arrival : Date: ______________ Time: ___________ Departure : Date : _____________Time:___________

Note: Hotel reservations are held till 1800 hours unless guaranteed by a credit card or deposit. You can provide us your credit card details for hotel booking purpose.

Hotel Equatorial : www.equatorial.com       Tel: (6-04) 643 8111   Fax: (6-04) 644 8000

Hotel Vistana     : www.ytlhotels.com          Tel: (6-04) 646 8000   Fax: (6-04) 646 8343 

Credit card: [   ] Visa  [   ] Master Card  [   ] Charged card

Card No.: _______________________________________________Expiry Date: _______________________

Cardholder’s name : ________________________________________________________________________

Cardholder’s signature :___________________________________ Date: _____________________________

4.  Post conference tour : I am interested in the post conference tour:

[   ]  Penang Orientation Tour (duration 4 hours) US$20.00

[   ]  Penang Hill & Temple Tour (duration 4 hours) US$30.00

[   ]  Georgetown Heritage Tour with Trishaw Ride-twin share (duration 4 hours) US$25.00

[   ]  Tropical Agro Farm Tour (duration 4 hours) US$35.00

[   ]  Trishaw Heritage Adventure Trail (Treasure Hunt) (duration 6 hours) US$40.00   

[   ]  Other tour options can be arranged but please indicate specify the place that you want to visit ___________

        _____________________________________________________________________________________

Note: This is an international friendship conference designed for participants to get to know each other through exploration of the various aspects of the state of Penang in casual and carefree manner. This will be very exciting experience for you. The conference volunteer and/or a tour guide will guide each group. Please select your option, as we need to inform our conference Tour co-coordinator committee to book for you in advance.     

5.  Conference Fees

Conference registration fee USD$250.00/RM950.00 includes entry to all sessions and the Exhibition, Conference bag, Final Programme book, proceedings/book, CSR journal CD-Rom, Cultural show, Souvenirs, morning and afternoon coffee/tea & snacks, lunches, the Welcome Reception, Conference Dinner and Gala & CSR’s Awards Night Dinner. For those who wish to bring spouse to attend the fee for your spouse is USD125.00/RM470.00. Registered with payment before 30 June 2004 is entitled to have a “See you at the Top” dinner at Penang Revolving Tower Restaurant or at a tallest Tower (59^th level) Restaurant located in Penang. This reward option is not applicable to organizing and scientific committee members. If you want to go for enjoying this dinner the cost per person is US$15.00/RM50.00. Please register in advance as only limited space available in the two prestige Restaurants in Penang.          

Any cancellation must be notified, in writing, to the Secretariat. Please refer to the following cut off date for cancellations. All refunds will be done after the conference. Bank and service charge will be deducted from the refunded amount. Cancellation by 1^st September 2004 (60%), Cancellation by 1^st October 2004 (50%) and Cancellation after 1^st November 2004 (No refund) 

Full payment for conference registration and post conference fees must accompany by your completed registration form and it should be made payable to : Ansted Service Center. Confirmation of registration will only be made upon receipt of your payment:

[   ]  By cheque (For Malaysian only) Cheque No.: ___________ Amount : ____________ Bank: ____________ 

[   ]  By wire transfer from your bank directly to the account below. A copy of the receipt of the bank remittance

       should be attached to the registration form. All bank transfer charges are to be paid by registrants.

       Bank Name : Standard Chartered Bank Malaysia Berhad       Swift Code  : SCBLMYKX

       Beneficiary  : Ansted Service Center                                          Account No.: 407-1-4453-202-4                                                   

[   ]  On-site registration will be available during conference although attendees are encouraged to register in

       advance. 

[   ]  an invoice or receipt of payment is required

Ø       How did you get the information on this workshop?

   [   ] From the Internet/Web-site. Which web site? _______________________________________________  

      [   ] From the workshop brochure, [   ] From the sponsors company, [   ] From my professional membership

      association/network/magazine/journal:___________________,  [   ] From your local Newspaper or Media

Ø       Who will provide you with the funding support? [   ] Self, [   ] My Company, [   ] Sponsored by____________

Ø       Please describe the main reasons why you want to attend this CSR Conference______________________

_________________________________________________________________________________________