Student Registration Form

AHRDC 2022 - Student

"*" indicates required fields

University/College Name*

Name of Programme/Course*

Upload Student ID

Max. file size: 2 MB.

Name*

First Last

Mobile Phone No*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Conference Only (Onsite)

Price: RM 99.00

Conference Only (Online)

Price: RM 49.00

Title

Name

Position

Mobile Number

Veg/Non-Veg (Onsite)

Click the "+" to add more delegates

Total

Credit/Debit Card

Card Details

Cardholder Name

Name

This field is for validation purposes and should be left unchanged.