REGISTRATION FORM (GROUP PASS) APPLIED 4.0: DIGITALIZING EMERGING TECH CONFERENCE Date: 17 & 18 March 2020 Venue: Sunway Putra Hotel, Kuala Lumpur Final Step for Group Pass Organization Name. Please type your Organization name here if the 4 of you are representing a Company. Otherwise, leave blank. Where did you learn about this Conference? Where did you learn about this Conference? Brochure Email Newspaper ads Newspaper article Facebook Instagram Word of Mouth Google Search / Website Others Payment Method - Secured Payment Gateway via Billplz (Please tick to proceed) Payment Method - Secured Payment Gateway via Billplz (Please tick to proceed) I understand that payment must be made in full via Billplz. Billplz is a secured payment gateway. Once payment is made, you will receive a proof of payment in your Inbox from them. To complete your registration, please head to https://www.billplz.com/B2SCApplied4170320B to make payment of RM18,000. Back2SchoolCo by Surge Connection Sdn Bhd is an official Marketing Partner for Applied 4.0: Digitalizing Emerging Tech Conference. Proceed to Billplz