The following information allows us to match your registration with your paypal payment. Therefore, to prevent delays or errors in processing your registration, please ensure the information is accurate, and that it matches or includes relevant information associated with your paypal account. If this does not function as it should for you, or if you have any other problems, please contact us at intconf@as4qol.org or at our inquiries page.
 
Items marked in blue are REQUIRED.  

Name

Note: Given differences in naming customs throughout the world, if the schema below does not apply to you, please help us correctly use your name by leaving a note in the message area below. We apologize for any error or offense.

Title: This is the title that would be used in a letter, e.g. Dear Dr. Livingstone
Mr.Ms.Mrs.Dr.Prof.   (other)  

Family Name: Examples: English: 'Bond, as in James Bond.' Japanese: 'Okamoto, as in OKAMOTO Taro.'  
Given Name(s): Examples: English: 'James, as in James Bond.' Japanese: 'Taro, as in OKAMOTO Taro.'  

Contact Information

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Fax Number:

Affiliation:

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ArubaAfghanistanAngolaAnguillaÅland IslandsAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntarcticaFrench Southern TerritoriesAntigua and BarbudaAustraliaAustriaAzerbaijanBurundiBelgiumBeninBonaire, Sint Eustatius and SabaBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaSaint BarthélemyBelarusBelizeBermudaBolivia, Plurinational State ofBrazilBarbadosBrunei DarussalamBhutanBouvet IslandBotswanaCentral African RepublicCanadaCocos (Keeling) IslandsSwitzerlandChileChinaCôte d'IvoireCameroonCongo, the Democratic Republic of theCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCuraçaoChristmas IslandCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaWestern SaharaSpainEstoniaEthiopiaFinlandFijiFalkland Islands (Malvinas)FranceFaroe IslandsMicronesia, Federated States ofGabonUnited KingdomGeorgiaGuernseyGhanaGibraltarGuineaGuadeloupeGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGreenlandGuatemalaFrench GuianaGuamGuyanaHong KongHeard Island and McDonald IslandsHondurasCroatiaHaitiHungaryIndonesiaIsle of ManIndiaBritish Indian Ocean TerritoryIrelandIran, Islamic Republic ofIraqIcelandIsraelItalyJamaicaJerseyJordanJapanKazakhstanKenyaKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, Republic ofKuwaitLao People's Democratic RepublicLebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMacaoSaint Martin (French part)MoroccoMonacoMoldova, Republic ofMadagascarMaldivesMexicoMarshall IslandsMacedonia, the former Yugoslav Republic ofMaliMaltaMyanmarMontenegroMongoliaNorthern Mariana IslandsMozambiqueMauritaniaMontserratMartiniqueMauritiusMalawiMalaysiaMayotteNamibiaNew CaledoniaNigerNorfolk IslandNigeriaNicaraguaNiueNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPitcairnPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People's Republic ofPortugalParaguayPalestine, State ofFrench PolynesiaQatarRéunionRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSouth Georgia and the South Sandwich IslandsSaint Helena, Ascension and Tristan da CunhaSvalbard and Jan MayenSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSaint Pierre and MiquelonSerbiaSouth SudanSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSint Maarten (Dutch part)SeychellesSyrian Arab RepublicTurks and Caicos IslandsChadTogoThailandTajikistanTokelauTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTuvaluTaiwan, Province of ChinaTanzania, United Republic ofUgandaUkraineUnited States Minor Outlying IslandsUruguayUnited StatesUzbekistanHoly See (Vatican City State)Saint Vincent and the GrenadinesVenezuela, Bolivarian Republic ofVirgin Islands, BritishVirgin Islands, U.S.Viet NamVanuatuWallis and FutunaSamoaYemenSouth AfricaZambiaZimbabwe

Conference Information

Check whichever apply (required):
As4QoL Membership status:
MemberNon-Member
 
Educational status:
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If you are a student please attach a copy of your student identification in jpg, jpeg, gif, png, or pdf format (up to 2 megabytes).
 
 
Dietary Preference:
NoneHalalVegetarian  
 
Type of Presentation
OralPosterNone  
 
Would you be interesting in participating in off-session events if they were offered:
YesNo  

Presentation Abstracts

NB: Presentation abstracts should be submitted from this page.

Have you submitted a presentation abstract? (required)
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If so, please give the full title
Don't forget proper capitalization and punctuation, please

Registration Information

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Japanese-OtherMalaysian

 
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Your registration is not complete until we receive payment. Note that payments may not be refundable. Please see our FAQ page for our full refund policy.   Thank you for your registration. Please contact us if you have any questions. See you in Penang.