iTec'19

Registration of Innovation Competition

REGISTRATION FORM

Participant Information:

Team Leader/Supervisor:

Full Name:

IC/Passport:

Contact No:

Email:

Team Member 1:

Full Name:

IC/Passport:

Contact No:

Email:

Team Member 2 (optional):

Full Name:

IC/Passport:

Contact No:

Email:

Team Member 3 (optional):

Full Name:

IC/Passport:

Contact No:

Email:

Team Member 4 (optional):

Full Name:

IC/Passport:

Contact No:

Email:

Institution/Company:

Malaysian Institutes/Industry (IPMa,IPT,Industry,etc)

International

Primary & Secondary School

Inst/Company Name:

Address:

City:

State:

Postal/Zip Code:

Country:

Project Background:

Cluster:

Electrical & electronic, ICT, Multimedia

Energy, Enviromental

Manufacturing process, Machines & Equipment, Automotive

Building Construction & Architecture

Science, Material, Social Science, Teaching & Training

Oil and Gas

Primary & Secondary School

Title:

Abstract
/Summary:

Facilities Required:

Project Size:

Payment Method:

Total Registration fees:

RM/USD

I hereby acknowledge that I have read and understood the terms and conditions as provided in the 'Rules & Regulation' as available at https://itec19.kktmkemaman.com/innovation.php and I agree to all of the terms.