Registration

ANeT MEMBERSHIP REGISTRATION FORM

Instruction: Please complete this form and send via airmail or fax to :

Prof. Datin Dr. Maryati Mohamed, Director

The Institute for Tropical Biology and Conservation

Universiti Malaysia Sabah

88999 Kota Kinabalu, Sabah MALAYSIA

Tel : +60 88 320104 Fax : +60 00 320291

or copy and e-mail it to : pejtbcu@ums.edu.my and bakhtiareffendi@yahoo.co.uk

Please also send your application to your respective country's representative

1.Name (Surname / family name in block letters) : ..................................................................................

2. Gender : [Male / Female]

3. Position : ........................................................................................................................................

4. Research Interest  ...........................................................................................................................

5. Academic Background ......................................................................................................................

6. Office Address : ..............................................................................................................................

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Country : .....................................   Zip Code : .............................................

Tel : ................................... Fax : .................................... E-mail : ..................................................

Do you agree that this information be made available to the public ? (YES/NO)

(OPTIONAL INFORMATION )

Home Address : .................................................................................................................................

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Tel : ................................ Fax : ................................. E-mail : ......................................................