PARTICIPATION FORM * Please return this form to the Secretariat before15th January 2013.
Secretariat, JAPAN – MALAYSIA SYMPOSIUM ON SUSTAINABLE CITIES IN ASIA, Research and Development Division, Federal Department of Town and Country Planning, Peninsular Malaysia Unit No.50-12-2B & 50-13-1, Wisma UOA Damansara, No. 50 Jalan Dungun, Damansara Heights, 50490 Kuala Lumpur. (Fax No. : 03 – 2094 1170) (Attn.: Mr. Muhammad Anwar B. Ramli / Mr. Mohd Parhan B. Md Subri) Tel.No : 03- 2081 6120 / 03 – 2081 6141
Japan - Malaysia Symposium (SUSTAINABLE CITIES IN ASIA) Date : 22nd January 2013 (Tuesday) / Time : 8.00 am – 2.00 pm Venue : Berjaya Times Square Hotel,Kuala Lumpur We are pleased to submit interested/selected participant(s) from our organization to attend the above Symposium. The details of the participants are as follows: Name : Position : Depart./Div./ Unit : Phone No. : Email : Name : Position : Depart./Div./ Unit : Phone No. : Email :
Participant 1
Participant 2
Note 1: Participation fee is free of charge. However, in the case of no show( without advance notice), the secretariat has the right to record the absent participants and notify it to the relevant chief of department. Note2: The secretariat will publish selected participants in the website of www.mytownnet.blogspot.com. No official letter will be issued by the Secretariat.
Thank you. ………………………………… Name : Organisation’sName : Address : Phone No. Email
: :
Fax No. : Date :