39TH SEANET CONFERENCE REGISTRATION FORM. Please submit before 15th October 2011

Please complete save it in your nameand email this form with your passport size photo to:

1. Participant Details:
Mr/Mrs : / Name on passport:
CALLSIGN: / Passport No :
Size of Shirt : (European Size) Please tick the appropriate box / Preferred Credential Name:
S / M / L / XL / 2XL / 3XL / 4XL
Organisation Name: / Designation :
2. Mailing Address:
Mailing address line 1:
Mailing address line 2:
Country : / Post Code:
3. Telephone & Contact :
Home: / Office :
Mobile Phone: / Fax :
Email address:
Please include your country code and area code
4. Accompanying Person ( Note: All singular conventioneers will share room with other singular participants):
Companion’s Name:
Companion’s Callsign: / Companion’s Credential name:
Size of Shirt : (European Size) Please tick the appropriate box
S / M / L / XL / 2XL / 3XL / 4XL
5. Special Accommodation Requirement ( eg. extra nights before and after the convention)
Pre Convention:
Post Convention: / Check-in date:
(Check –in 21/11/2011 noon) / (Check-out 17/11/2011 noon)
Check-out date:
6. Registration Fee and Payment method:
The total convention package registration fee is US$500 per person, including conference, tours, meals and twin sharing room accommodation(An additional B$300 is required if you wish single room occupancy). Payment by CASH upon Registration or BANK TRANSFER.
Pay to : Account Name: Persekutuan Radio Amatur Negara Brunei Darussalam
Account Number: 00-014-03-0067479
Bank Name : Bank Islam Brunei Darussalam
Swift code No: BIBDBNBB
7. Transportation:
Please complete section 8 below to confirm transportation arrangements from the airport to hotel.
8. *Arrival & Departure Flight Details:
Flight No : / Date of Arrival / Time of Arrival
Flight No: / Date of Departure / Time of Departure
* If not available right now, please email to when it is available
9. Dietary Requirements:
Please advise your special dietary requirements (eg: dietary food, Vegetarian food etc)
10. Do you need any assistance in your visa application (eg. invitation letter) ? Please specify
11. By submitting this form, I confirm the above details and my intention to register for the 39th SEANET Convention 2011 to be held in Brunei Darussalam 17th – 21st November 2011.
Signature: / Date:

NOTES FOR COMPLETION OF REGISTRATION FORM

The following numbered notes correspond with those in the Registration Form.

1. The leading conventioneer should complete this section (e.g. husband or wife of a couple).

The credential name is the name or callsign to be put on your name tag.

2. Please complete the mailing address of the leading conventioneer.

3. Please give the contact details of the head of your group/family. Please ensure that your email

address is correct as we will contact you through this email address to confirm your registration

and if necessary, advise how to make advance payments and/or deposit to guarantee your

hotel reservations.

4. Please give the name(s) and credential name(s) of your companion(s).

5. For extra accommodation pre and post convention only. Please note that the fees and room

charges may be subject to change and availability.

6. Payment can be made in cash upon registration OR by bank transfer.

You may make the payment by bank transfer to the following bank account and send the evidence

of payment to theorganizing committee by email . Please indicate the payer's name/entity. Please

show the copy of the evidence of payment upon registration.

email:

Pay To:Account Name : Persekutuan Radio Amatur Negara Brunei Darussalam Account No : 00-014-02-0067479

Bank Name:Bank Islam Brunei Darussalam

Swift code No:BIBDBNBB

7. Please note that airport transportation is included. (Hotel to Airport , and Airport to Hotel). Incase

youmiss the airport pick-up, please take the public transport at the airport.

8. If you require us to arrange alternative transportation from airport to hotel or hotel to airport, please

advise us of your arrival and departure details.

9. Please advise us of your special requirements on food, and medical requirements if any.

10. Please indicate if you need our assistance for your visa application. If required, we can issue an

officialinvitation letter and provide all other necessary assistance.

Please complete the above form, save it your name or Callsign and email it together with your passport-size photograph

Your signature will not be necessary if the form is sent to us by email, however, you may be requested to sign your application form upon checking in after your arrival.