Title: (Mr. Mrs. Dr. Ms)              First name:                                                   Last name:

Institution:

Department                                                                     Email: 

Mailing address:

City:                                                           State:                                 Postal/ Zip code:       

Country:                                                   Telephone:                                       Fax:

Broad Field of Research: (e.g. Banking, Management, etc.)

Are you willing to serve as a session chair for a session?                 Yes      No

Are you a Fellow of the World Business Institute?                             Yes      No

Paper No.                  (see acceptance letter)                                       Special dietary requirements:

Code

Description  ( See Registration Fee schedule Attached)

Fee

Payment Method

r

International transfer

For  personal check and Bank check :  Pay to : World Business Institute

For Money order  :  World Business Institute,  Branch/Account . 033-090- 303339,  Westpac Banking Corporation,  302 Clayton Road, Clayton, Melbourne, Victoria 3168, Australia  

For Wire Transfer:  Swift Code: WPACAU2S 

r

Credit Card    : Type: r Visa  r Master Card

Name on Card: ___________________________________________________

Number: __ __ __ __    __ __ __ __    __ __ __ __    __ __ __ __

Expiry date: _____ / _____

Receipt will be provided at the conference registration day (12 July 2010) unless urgently required.