Welcome to Global Leadership Summit Malaysia

I am registering as:

IndividualGroup

Date of Registration:

For Group Registration

• Each member must complete a registration form

• Appoint a Group Leader

• Attach ALL six forms and FULL payment when sending cheque or bank draft

ABOUT YOU

Email*

Name*

Mobile Number*

e.g. 60128888888 [Country Code][Mobile No.]

Gender*

MaleFemale

Birthday

e.g. dd/mm/yyyy

Address

Country*

Postcode

City

State/District

Home Phone

Office Phone

ABOUT YOUR CHURCH

Church:

Denomination:

Your ministry:

REGISTRATION & PAYMENT DETAILS

Mode of Payment:

Check/Bank Draft No:

Bank:

Amount (RM):

Cheque/bank draft payable to:
AGAPE GOSPEL ASSEMBLY

Mail check/bank draft to:
THE GLOBAL LEADERSHIP SUMMIT 2010
c/o Anne Tan
Agape Gospel Assembly
P.O. Box 309, 70730 Seremban,
Negeri Sembilan,
Malaysia

•	FULL payment MUST accompany registration form within one week of registration.
•	Registration NOT accompanied by FULL payment within one week of submission shall be deemed null and void.
•	A confirmation letter will be sent to you upon receipt of payment.
•	There will be NO refund of fees but registration is transferable.
•	Local check to be made payable to: AGAPE GOSPEL ASSEMBLY Please write your name (as per registration) and contact number on the reverse of the check.
•	Payment of overseas registration can be made via bank draft made payable to: AGAPE GOSPEL ASSEMBLY

DISCLAIMER: The Organiser reserves all rights to change any of the published conference details without notice and has the final say on any matter relating to the conference.

PARENTS WITH CHILDREN: While families are important to us, unfortunately there is no accommodation for children or nursing infants, and we will not be able to admit them into any of the sessions. If you are registering others who have small children, please relay this information to them.

MODEL RELEASE: For promotional purposes, videos and photographs are taken at all conferences. Your registration constitutes permission for the Organiser to use your picture in promotional materials.

Yes, I hereby confirm that I have read and understood the privacy policy, terms and conditions of GLS Registration and agree to it.