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ASEA UNINET SUSTAINABILITY ISSUES WORKSHOP
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1. PERSONAL INFORMATION
Title
*
Assoc. Prof. Dr.
Dr.
Mr.
Mrs.
Ms.
Other:
Name
*
Your answer
Nationality
*
Your answer
Gender
*
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Organization/Institution
*
Your answer
Position
*
Your answer
Passport no.
*
Your answer
2. CONTACT INFORMATION
Phone Number
*
Your answer
Email Address
*
Your answer
3. DIETARY RESTRICTION
Food/Dietary Restriction
*
None
Halal food
Vegetarian food
Other:
4. FLIGHT DETAILS
Arrival Details
Arrival Date
*
MM
/
DD
/
YYYY
Arrival Time
*
Time
:
AM
PM
Airlines Name
*
Your answer
Flight No.
*
Your answer
Departure Details
Departure Date
*
MM
/
DD
/
YYYY
Departure Time
*
Time
:
AM
PM
Airlines Name
*
Your answer
Flight No.
*
Your answer
5. HOTEL RESERVATION (GRAND SEASONS HOTEL, KL)
Check in Date
*
MM
/
DD
/
YYYY
Check out Date
*
MM
/
DD
/
YYYY
Do you need a confirmation letter on your name?
*
Yes
No
Room type
*
Single (MYR205.00)
Twin (MYR230.00)
6. NOTE/Special Request
Your answer
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