Graphene Malaysia

REGISTRATION

Graphene Malaysia 2017 Conference
Kuala Lumpur (Malaysia) 10-11 July, 2017

Registration Form

Gender(*)	Male Female
Title(*)
First Name(*)
Last Name(*)
Institution/Dept.(*)
Address(*)
City(*)
ZIP Code(*)
Country(*)	Malaysia
Phone(*)
E-Mail(*)
VAT Number
Doctoral Student(*)(a)
Poster contribution
How did you hear about the Conference Graphene Malaysia 2017? (*)

Graphene Malaysia Conference Fees ( ) More info

Participants

	Before June 05	After June 05
Senior	0€ (RM1200)	0€ (RM1450)
Student (a)	0€ (RM1000)	0€ (RM1200)
Exhibition pass (Only for exhibiting companies)	0€ (RM450)	0€ (RM550)

Exhibition Fee

	Before May 22	After May 22
(Stand 2X3 m2 - Space rental)	0€ (RM1500)	0€ (RM1800)
(Stand 2X2 m2)	0€ (RM2000)	0€ (RM2400)
(Stand 2X3 m2)	0€ (RM2500)	0€ (RM3000)
(Stand 3X3 m2)	0€ (RM3200)	0€ (RM3800)

If you’re paying by credit card, event thought the price appears in € you will be charged by your bank in RM.
If you’re paying by bank transfer, you have to pay the exact amount in € to our bank account without taxes, bank charges, etc.

(*) Mandatory fields
(a) Justification signed by your PhD Adviser should be sent by e-mail (info@graphenemalaysiaconf.com)

Additional Info

Arrival Date: Departure Date

Type of participation

P A Y M E N T

Invoices will be sent on behalf of a legal person (university or company) without VAT (except Spain). If an invoice is requested by a natural person, the VAT should be added.

(*) For Credit Card payment, a 2,5% (bank costs) will be applied.

1) Bank transfer to the order of "Fundacion PHANTOMS" must bear the mention "FREE OF CHARGE TO THE RECEIVER" and must indicate GrapheneMalaysia2017 Conference and LAST and FIRST NAME of the participant to facilitate identification and to the following bank account:

    CaixaBank SA, Calle Ibiza 64, 28009 Madrid (Spain)
    BIC (Bank Identifier Code): CAIXESBBXXX
    IBAN (International Bank Account Number): ES55 2100 6441 5122 0002 0128
    Phantoms Foundation VAT Number: ES G83352724

PLEASE, SEND BY email (info@graphenemalaysiaconf.com) A COPY OF YOUR BANK TRANSFER MAKING CLEAR THE NAME OF PARTICIPANTS TO GrapheneMalaysia2017 CONFERENCE.
ALL BANK CHARGES SHOULD BE PAID BY THE APPLICANTS.

2) Credit card [ VISA - MasterCard ]

To validate the Registration Form, please write the following code:

CANCELLATION OF CONFERENCE PARTICIPATION
All cancellations should be made in writing by e-mail to Dr. Antonio Correia.
Participants:
50% of the registration fee payment will be reimbursed, if a cancellation is received Until June 01, 2017
No reimbursement will be made after June 02, 2017

Exhibitors:
50% of the registration fee payment will be reimbursed, if a cancellation is received Until May 11, 2017
No reimbursement will be made after May 12, 2017

INSURANCE
The Organisation Committee will not be responsible for any medical expenses, lost property, or accidents during the GrapheneMalaysia2017 Conference and we strongly recommend that participants make all necessary insurance arrangements for themselves.