COURSE'REGISTRATION'FORM'ARBITRATOR'TRAINING'COURSE'(ATC)'FOR'FELLOWS'

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Tel:&03(62035457&&&&Fax:&03(62035471& E(mail&:&ciarbmb@gmail.com&''

Name :

Title :

CIArb Membership No:

Date of Birth : Gender : Male / Female

Address :

Postcode : Country :

Delivery Address (if different from the main address – for course materials and results) :

Tel (Office) :

Mobile:

E-mail :

Job Title :

Industry :

Employer :

Experience in Dispute Resolution and/or Arbitration (if any) :

APPLICANTS ARE REQUIRED TO ATTACH THEIR CV, SHOWING DETAILS OF THEIR EXPERIENCE IN ARBITRATION OR DISPUTE RESOLUTION.

Malaysia'''

PERSONAL'DETAILS'

Please find enclosed a cheque / bank draft no ………………....................

made payable to “The Chartered Institute of Arbitrators Malaysia Branch”

If payment is made by bank transfer, this should be made payable to : “The Chartered Institute of Arbitrators Malaysia Branch”

Payable to Account No: 1425 0000 689 05 SWIFT Code: CIBBMYKL

Bank Address: CIMB Bank Berhad Ground Floor Menara Binjai, 2 Jalan Binjai, 50490 Kuala Lumpur, Malaysia. Tel: 603 2181 3136 Fax: 603 2181 2702

WHEN MAKING PAYMENT, PLEASE STATE YOUR NAME AND THE DATE OF THE COURSE AS THE REFERENCE CODE FOR IDENTIFICATION PURPOSES.

Cancellation Policy :

(1) Before 7 March 2014, 50% refund. There will be no refund if cancellation is made after 7 March, 2014.

(2) Any “no show” by candidates on the Course Date will be liable to full payment and no refund will be made.

How did you hear about the Institute? Do you have any special dietary requirements? Please specify : Do you have any disabilities that we should be aware of so that reasonable adjustments may be made? Please specify :

Cheque&/&Bank&Draft&&

FEES':''The'course'fee'for'Arbitrator'candidates'is'RM6,800.00'/'USD2,100.00'net'per'candidate.'The'course'fee'for'Advocate'candidates'is&RM6,000.00'/'USD1,900.00'net'per'candidate.'

'

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& Telegraphic&Bank&Transfer&

OTHERS'