Pan Commonwealth Forum - Registration Form

PAN	Commonwealth	1 - 5 March 1999

	FORUM ON OPEN LEARNING	Bandar Seri Begawan
	Empowerment through Knowledge and Technology A Celebration of Ten Years of The Commonwealth of Learning Co-hosted by the Brunei Darussalam Ministry of Education and Universiti Brunei Darussalam


The Commonwealth of Learning	Ministry of Education Brunei Darussalam	Universiti Brunei Darussalam

Registration Form

Registration

Title: o Ms. o Mrs. o Mr. o Dr. o Prof. o Other ____________________________

First Name: _________________________________ Last Name: _____________________________________________

Position: ___________________________________________________________________________________________

Organisation: _______________________________________________________________________________________

Address:____________________________________________________________________________________________

City: ______________________________________ State/Province: __________________________________________

Postal Code: _________________________________ Country: _______________________________________________

Telephone: ________________________ Fax: ________________________ E-mail: ____________________________

(country/area code)

Preferred Name for Badge:_____________________________________________________________________________

Special dietary requirements: ___________________________________________________________________________

Special physical access requirements: ______________________ ______________________________________________

Registration Fees

Full Conference Fee: US$400 (includes all sessions, materials, breakfasts, lunches, dinners, transport,

accommodation at UBD Student Hostel on applicable days)

Companion Fees: US$100 (includes three official banquets on evenings of 1, 2 & 4 March 1999)

o US$400 (Full Conference Fee) o US$100 (Companion Fees) Name of Companion: __________________________

Method of Payment

o Enclosed is my registration fee of US$___________ (bank draft or money order in US funds)
payable to : The Commonwealth of Learning.

o Credit Card (VISA only)

Name of Card Holder: _____________________________ Card Number: ________________________________

Signature: _______________________________________ Expiry Date: ________________________________

Visa Application (To be completed by delegates coming from countries without Brunei diplomatic missions.

Please refer to the Passports and Visas Section in the Information for Delegates document for details.)

Name of Registrant:
______________________________________

Passport No. : _____________________________________

Expiry Date: ________________________________

Date of Issue: _____________________________________

Place of Issue: ________________________________

o Passport copy attached
o Passport size photo attached

Accommodation Information

(Please note that guest house/hotel reservations made via the registration form will be entitled to a

special negotiated discount rate.)

Accommodation	Cost
Student Hostel at Universiti Brunei Darussalam (UBD) Single room with fan and single bed. Shared bathroom and laundry facilities. Segregated male and female hostels.	No charge – first come, first served
Guest House at Universiti Brunei Darussalam (UBD)	B$45 per person per night
ASEAN-EC Management Centre	B$50 per person per night B$10 per day for extra bed
SEAMEO VOCTECH International House	Standard Twin B$70 per night Superior Twin B$90 per night Junior Suite B$120 Family Suite B$200 Extra Bed B$15 (Rates are subject to 5% service charge)
Sheraton Utama Hotel	From B$198 per night *
The Centrepoint	From B$166 per night *
Riverview Hotel	From B$131 per night *
Brunei Hotel	From B$115 per night *
Terrace Hotel	From B$96 per night *

* Rates are subject to 10% service charge.

Choice of Accommodation:

1^st Choice _________________________________________________________________

2^nd Choice _________________________________________________________________

3^rd Choice _________________________________________________________________

No. of Room Nights: ____ Date of Arrival/Departure: _________________________________

For those choosing UBD Student Hostel, please specify: o Female o Male

For those choosing SEAMEO VOCTECH International House or hotels, please specify:

Type of Room: ________________________ Name of Sharing Person (if applicable): ___________________________

PLEASE PRINT AND COMPLETE THIS FORM — AND SEND WITH PAYMENT TO:
Forum Secretariat
Pan-Commonwealth Forum
The Commonwealth of Learning
1285, West Broadway, Suite 600
Vancouver, B.C. V6H 3X8
CANADA

OR FAX to: 604-775-8210

NOTE : No refunds will be made after 1 February 1999. Refunds are subject to an administration fee of US$50.

Partial subsidies will be considered on a case-by-case basis for participants from developing Commonwealth countries.

Registration Deadline: 1 December 1998

Early registration is encouraged, as space is limited.

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