Welcome to USM Short-Term Courses

	*Registration and Conditions*

	UNIVERSITI SAINS MALAYSIA Division of Industry & Community Network (ICN) Registration for Short Term Courses

	Course Code

Course Title

Participant's Particulars

Name (as in NRIC)

NRIC No.

Gender

Company & Current Position

Company name

Current Position

Address

Postcode

Tel (Office)

Mobile

Fax

E-mail

Registration and Payment Conditions

Payments in the form of crossed cheque/bank draft/money order and made payable to Bendahari USM. Payment to be received by ICN at least 14 days prior to the commencement of the course.

Full refund for cancellation can be made provided written notice is received by ICN not less than seven (7) days prior to the commencement of course. There is no refund for non-attendance or no-show.

Participants are responsible for all other extra expenses incurred during the course.

Participation is based on first come first served basis.

USM reserves the right to change the dates the courses are offered and to cancel the offering of any course.

Reminder

Although the Registration Form may be emailed or faxed ahead to ICN, your registration can only be confirmed subject to receipt of payment of fee(s) in full as per deadline stipulated above..

Payment to be enclosed with hard copy of Registration Form

Enclosed cheque / bank draft / money order made payable to Bendahari USM.

Important: Please write clearly at the back of the cheque/bank draft/M.O your name, NRIC, address, phone no. and course code.

Please mail Registration Form and payment to:

Division of Industry & Community Network,
Chancellory,
Universiti Sains Malaysia,
11800 USM
Penang

Fax: (04) – 653 2903
Email : shortcourses@usm.my

Call Centre no.: 04 – 653 2902

Blank Registration Form(s) for circulation to other interested parties :

If you wish to print a spare Registration Form, please download here.