74th District 3300 Conference // 02-04 January 2009
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Kindly refer to our website: http://www.districtconference3300.org
for conference information such as conference programmes,
hotel rates etc. 

Complete the following and return the form by attaching this document 
to an email with the subject heading DC3300 REGISTRATION and send to the 
email address
	
	fskc@nyoklan.com.my


Registration Details:

SECTION 1
---------
Full name	:
Rotary Name	:
Rotary Club	:
Name of Spouse	:
Name of Guest(s):
		 (use commas to seperate if more than one)
Postal Address	:
Telephone (home):
Telephone (off.):
Handphone	:
Fax Number	:
Email address	:


SECTION 2
---------
Name of Hotel	:
Type of Room	:
Number of Rooms	:
Check in Date	:
Check in Time	:
Check out Date	:
Check out Time	:

Vegetarian Meals: YES / NO

Refer to our website http://dc3300.myfreesites.com for
a comprehensive list of hotel rooms & rates.


SECTION 3
---------

Payments
Fill in with the following format : Number of person x Rate
e.g. 3person x RM350
	
Rotarian (RM300, RM350, RM400)/pax		:
*Early bird before 31 Oct, 08 	= RM300
 Thereafter till 31 Dec, 08	= RM350
 On site			= RM400

Spouse & Guests (RM300, RM350, RM400)/pax	:
*Early bird before 31 Oct, 08 	= RM300
 Thereafter till 31 Dec, 08	= RM350
 On site			= RM400

Extra Fellowship Dinner (RM75/pax)		:
Golf Fellowship (RM175/pax)			:
Cricket Fellowship (RM75/pax)			:
Hotel Deposit (1 night)				:


Total Payment					:



SECTION 4
---------

Payment method

a. Cash		

b. Direct Debit : RHB A/C No.: 2-08256-0001755-3 
		  (Rotary Club of Teluk Intan)

c. Enclosed Cheque and made payable to "Rotary Club of Teluk Intan"
   - Cheque amount	:
   - Bank		:
   - Cheque No.		:

d. Via credit cart
   Applicable to VISA & MasterCard member only & will be charged
   to "HOTEL ANGSOKA", Teluk Intan.

   VISA / MASTERCARD  (Delete whichever not applicable)

   - Card Expiry Date		:
   - Name on Card		:
   - Card number		:
   - 3 digit security pin	:
     (printed on the back of your credit card)

   If you are having problems or enquiry about any of the payment
   methods kindly contact: 

	PP Fong Seoq Kai Chuan 
	+6019 575 6288
	fskc@nyoklan.com.my


DECLARATION

By sending this application document upon completion to 
the email address, fskc@nyoklan.com.my, I confirm that
the information given above is correct.


	Kindly refer to our website: http://dc3300.myfreesites.com
	for conference information such as conference programmes,
	hotel rates etc. 


	Return the completed form by attaching this document to an 
	email with the subject heading DC3300 REGISTRATION and send 
	to the email address
	
		fskc@nyoklan.com.my

	For any other enquiries kindly contact:

	The Conference Secretariat	
	Pusat pakar Rajindar Singh
	20F, Jalan Changkat Jong,
	3600 Teluk Intan,
	Perak D.R., Malaysia
	Tel.: +605 621 1112
	Fax : +605 621 1444

	PP Fong Seoq Kai Chuan 
	+6019 575 6288
	fskc@nyoklan.com.my


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SECTION 5
---------

For official use only

Registration Received On	:
Registration Number Alloted	:
Payment received On		:
Via Credit Card/Cheque/Cash	:
Receipt No.			:

Hotel Confirmed			: SYUEN / CASUARINA / EXCELSIOR / HERITAGE

Room Number			:


Checked & Confirmed by		:
Date				:
Remarks				:


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************************ FOR OFFICIAL USE ONLY ************************

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