Rego Form Gsd '09 International

5th Great Serdang Debate Championship (GSD) 17 th – 20 th August 2009 Kolej Tun Dr. Ismail, Universiti Putra Malaysia

REGISTRATION FORM Institution Information Institution Name ___________________________ Institution Address______________________________________________________________ ______________________________________________________________ Contact Person Information Name _________________________________ Job Title _______________________________ Telephone _____________________________ Facsimile ______________________________ Email _________________________________ Signature ______________________________ Terms of Payment Registration Fee (Speaker) USD 120 per participant X ______ Registration Fee (Adjudicator) USD 100 per participant X ______ Total Fees USD _______________ (Inc. surcharge for banking charges @ 5% for institution outside Malaysia)

□ I will post a Cheque made payable to Bendahari Universiti Putra Malaysia □ I would like to pay cash upon registration Contact Details Corresponding address: Committee Great Serdang Debate Championship 2009 (Attn: Anthony Lee Kim Hong) Kolej Tun Dr. Ismail Universiti Putra Malaysia 43400 UPM Serdang, Selangor, Malaysia Fax us at +603 89467364 or email to [email protected] Team/s* Team Name ___________ Speakers 1 __________________________________ 2 __________________________________ Team Name ___________ Speakers 1 __________________________________ 2 __________________________________

Team Name ___________ Speakers 1 __________________________________ 2 __________________________________ Adjudicator/s 1 __________________________________ 2 __________________________________ 3 __________________________________ 4 __________________________________ 5 __________________________________

* For institutions sending more than three teams, please use another copy of the registration form.