41st SKAL ASIA CONGRESS
PENANG, MALAYSIA
10 - 13 MAY 2012
REGISTRATION FORM
(email to: seeyou@skalpenang2012.org)
DELEGATE INFORMATION:
SURNAME:
SALUTATION
Mr
Mrs
Dr
Ms
GIVEN NAME:
SKAL Club / Country:
Albany Western Australia
Ahmedabad, India
Bacolod, Philippines
Bahrain, Bahrain
Bali, Indonesia
Bangalore, India
Bangkok, Thailand
Bangladesh, Bangladesh
Bombay, India
Calcutta, India
Cebu, Philippines
Chennai, India
Cochin, India
Colombo, Sri Lanka
Davao, Philippines
Delhi, India
Dubai, UAE
Goa, India
Guam, USA
Chiangmai & North Thailand, Thailand
Hong Kong, China
Hua Hin, Thailand
Hyderabad, India
Incheon, Korea
Jakarta, Indonesia
Kaohsiung, Taiwan
Kathmandu, Nepal
Koh Samui , Thailand
Kuala Lumpur, Malaysia
Macau, China
Makati, Philippines
Manila , Philippines
Mauritius, Mauritius
Nagoya, Japan
Osaka, Japan
Pattaya & East Thailand, Thailand
Penang, Malaysia
Phnom Penh, Cambodia
Phuket, Thailand
Pune, India
Seoul, Korea
Siem Reap, Cambodia
Sihanoukville-Kep-Koh Kong, Cambodia
Singapore, Singapore
Taichung, Taiwan
Taipei, Taiwan
Tokyo, Japan
Siem Reap - Cambodia
Phnom Penh - Cambodia
Sihanoukville-Kep-Koh Kong - Cambodia
Company Name:
Company Address:
Email
Telephone
-
-
Fax
-
-
Arrival Date:
Flight Number:
ETA
(e.g: 22:00 ):
Departure Date:
Flight Number:
ETD
(e.g: 22:00 ):
Accompanying Person/Spouse Name:
SALUTATION
Mr
Mrs
Dr
Ms
Special Requirements:
Shirt/Dress Size: Please Indicate Your Shirt/Dress Size:
Delegate:
M
L
XL
XXL
XXXL
(40cm)
(42cm)
(44cm)
(46cm)
(48cm)
Accompanying Person / Spouse:
M
L
XL
XXL
XXXL
Complimentary Tour
(Duration 3 hours) - departs 2.30pm from Congress Hotel
Please select (tick) one tour of your choice daily.
11 May 2012 (Friday)
12 May 2012 (Saturday)
George Town Heritage Tour
George Town Heritage Tour
Nature Tour
Nature Tour
Penang Hill Tour
Penang Hill Tour
Total number of persons joining:
Congress Package:
(Rates are inclusive of three nights accommodation, all meals, transfers and complimentary tours)
Register & Pay before 15 January 2012 to qualify for our EARLY BIRD special !
Choice of Hotel
EARLY BIRD SPECIAL
15 January 2012
After 15 January 2012
Additional Night’s Stay (pre/post Congress)
TWIN
SINGLE
TWIN
SINGLE
PER ROOM PER NIGHT inclusive breakfast(s)
Cititel Penang
Congress Hotel
(
Superior Hotel
)
USD450
USD650
USD480
USD685
USD80
Check-in date:
Check-out date:
The Eastern & Oriental Hotel
(
Deluxe Hotel
)
USD500
USD720
USD530
USD755
USD120
Check-in date:
Check-out date:
Hard Rock Hotel
(
Superior Hotel
)
USD490
USD700
USD520
USD735
USD100
Check-in date:
Check-out date:
Holiday Inn Resort
(
Superior Hotel
)
USD480
USD680
USD510
USD715
USD90
Check-in date:
Check-out date:
Red Rock Hotel
(
Tourist Hotel
)
USD430
USD630
USD460
USD665
USD60
Check-in date:
Check-out date:
1926 Heritage Hotel
(
Tourist Hotel
)
-
-
-
-
USD60
Check-in date:
Check-out date:
Congress Only
USD400
Pre-Congress Tours
: (08 May 2012 - 10 May 2012) /
Post-Congress Tours
: (13 May 2012 - 15 May 2012)
Penang / Kuala Lumpur
Kindly refer respective Tour Programmes, as attached
Penang/Pangkor Island /Kuala Lumpur
Penang / Cameron Highlands/Kuala Lumpur
Penang/Sabah (Borneo)
PAYMENT DETAILS
Via Bank Transfer
Account Name:
Skal Club Of Penang
Current Account No:
007143308228
Swift Code:
MBBEMYKL
Bank Name:
Maybank Tanjung Bungah Branch
Bank Address:
2-C Azuria Business Centre,
Jalan Lembah Permai, 11200 Penang, Malaysia
Via Credit Card
Kindly write to Ms Siew Lin or Mr Marco G. Battistotti at
seeyou@skalpenang2012.org
Registration & Payment:
Early Bird Special: please register and pay before 15 January 2012
After 15 January 2012: please register and pay before 31 March 2012
Congress Only: please register and pay before 31 March 2012