PAYMENT METHOD

REGISTRATION INFORMATION

The total amount must be paid in advance of the event. Walk-in participants with payment will be admitted on a ‘space availability’ basis only.

MODE OF PAYMENT:

:

By registering for the SPAD LPT Symposium 2017, I accept the terms & conditions on the back of this page.

Date: ____________________________________

Signature: ____________________________________

SURUHANJAYA PENGANGKUTAN AWAM DARATLAND PUBLIC TRANSPORT SYMPOSIUM 2017

Yes, I want to purchase Gala Dinner Table(s) only Symposium Pass(es) only Gala Dinner Table(s) & Symposium Pass(es)

“Reimagining Transportation: Sustainable Mobility”

LPT Symposium 2017

Monday, 23rd October 2017 Plenary Hall

KL Convention Centre

Liaison PersonOrganisation

Mailing Address

Salutation

Name

E-mail

Designation /Job Position

Gala Dinner & Industry Awards

Symposium

REGISTRATION FORM

BANK DRAFT / CHEQUEBANK DRAFT / CHEQUE NO: _____________________ BANK: _____________________

AMOUNT: _____________________________________

Cheques or bank drafts should be crossed and made payable to Kumpulan Wang Suruhanjaya Pengangkutan Awam Darat

BANK TRANSFERPAYEE NAME: Kumpulan Wang Suruhanjaya Pengangkutan Awam DaratBANK : Maybank Islamic BANK BRANCH : KL SentralACCOUNT NO 564717003707 SWIFT CODE : MBBEMYKLBANK ADDRESS: Lot No. 7, 8 & 9, Departure Hall, KL Sentral, 50470 Kuala Lumpur

Please send the proof of payment and a copy of your registration form to rozalpts@spad.gov.my after payment has been made.

CASH

LPT Gala Dinner & Industry Awards 2017

Sunday, 22nd October 2017Conference Hall 1, 2 & 3KL Convention Centre

List of Delegates

Kindly send / email this entire form to:Address : Suruhanjaya Pengangkutan Awam Darat (SPAD) Block D, Platinum Sentral, Jalan Stesen Sentral 2 Kuala Lumpur Sentral, 50470 Kuala Lumpur, Malaysia Email : rozalpts@spad.gov.myWebsite : www.spad.gov.my

If you have any questions regarding the:

Roza Amira Tel: +603 2726 7333 rozalpts@spad.gov.myEmail:

TOTAL AMOUNT: RM

• LPT Symposium, kindly contact

• LPT Gala Dinner & Industy Awards, kindly contact:Yusnaida Yasin Tel: +603 2726 7197Email: yusnaida@spad.gov.my

Purchase of Pass(es) Number of Pass(es) Type of Pass Price per Pass Notes

Early Bird Pass RM 490.00 Available up to and including 22nd September 2017

Tri-Pass

RM 400.00

(1) For 3 passes only; and

(2) Available up to and including 16th October 2017

Group Pass

RM 330.00

(1) For minimum of 4 passes and above; and

(2) Available up to and including 16th October 2017

Regular Pass RM 600.00 Available up to and including 20th October 2017

Walk-in Pass RM 700.00 Available on 21st October 2017, 22nd October 2017 and 23rd October 2017

Purchase of Table(s) Number of Table(s) Price per Table

RM 8,000.00

List of Delegates for Symposium

Name Designation / Job Position(and Organisation Name, if different from above) E-mail

LPTSYMPOSIUM

2017

Note: Please print additional forms for more names

Tel

Name

No

TERMS & CONDITIONS

• Registration forms to be sent to SPAD by hand or email only.

• The registration form serves as a contract between the participant(s) and SPAD. Thus, only fully completed registration forms will be accepted.

• Registration fees do not include transport or accommodation. After your registration form is received, you will receive a confirmation email.

• If payment is to be effected by bank transfer, please ensure that all costs for the transfer are borne by the payee and payment is effected NET. Bank charges have to be borne by the participant(s).

• If payment is made by cheque, please state name of company, contact person and contact phone number at the back of the cheque. Email the copy of the bank-in slip to rozalpts@spad.gov.my.

• Please send proof of payment and reference number to rozalpts@spad.gov.my after payment has been made.

• Please note that payment needs to be cleared in our account by 20th OCTOBER 2017 and that entrance to the Gala Dinner and / or Symposium is assured only upon receipt of full fees.

• Registered participant(s) whose payment is not received in our account will not be allowed to participate in the Symposium.

• The organisers reserve the right to stop any registered participant(s) from taking part in the Symposium.

• If a participant is unable to attend the event, we will accept a substitute.

• All requests for substitutions must be submitted BEFORE 17th OCTOBER 2017 indicating the name of the cancelled participant and the substitute.

• For cancellations, a refund minus 30% service charge will be sent to the said participant if cancellation is received in WRITING BEFORE 17th OCTOBER 2017. The refund will be made payable within 30 days.

• No refunds will be made for cancellations received ON OR AFTER 17th OCTOBER 2017.

• No-shows will not qualify for a refund.

• SPAD reserves the right to make any amendments to the programme, terms & conditions or any related activities at its discretion.

Kindly send / email this entire form to:

Address : Suruhanjaya Pengangkutan Awam Darat (SPAD) Block D, Platinum Sentral, Jalan Stesen Sentral 2 Kuala Lumpur Sentral, 50470 Kuala Lumpur, Malaysia Email : rozalpts@spad.gov.myWebsite : www.spad.gov.my

If you have any questions regarding the:

• LPT Symposium, kindly contact:

(1) Ashok Panchalingam Tel: +603 2726 7366 Email: ashoklpts@spad.gov.my (2) Raja Nur Farzana Tel: +603 2726 7360 Email: zanalpts@spad.gov.my (3) Roza Amira Tel: +603 2726 7333 Email: rozalpts@spad.gov.my (4) Saira Banu Tel: +603 2726 7102 Email: sairalpts@spad.gov.my (5) Nurul Atiqah Tel: +603 2726 7255 Email: atiqahlpts@spad.gov.my

• LPT Gala Dinner & Industry Awards, kindly contact:

(1) Surina Adnan Tel: +603 2726 7024 Email: surina@spad.gov.my (2) Yusnaida Yasin Tel: +603 2726 7197 Email: yusnaida@spad.gov.my