Directors Tea Talk Registration Form Title: The Rise of Digital Business Industry Visions Date: Thursday, 18 May 2017 Time: 2.00pm – 5.00pm Venue: Equestrian Club, Mont Kiara An Event Supported By Registration Form ORGANISATION’S DETAILSCompany/Organisation*MACD Members / Members of Supporting Bodies*MACDACCABoardRoomCrowe HorwathFPLCMASSANon Member*MACD Member: RM 100 Members of Supporting Bodies: RM 100 Non MACD Member: RM 150Industry*Consumer ProductsIndustrial ProductsConstructionTrading/ServicesInfrastructureFinanceTechnologyHotelsPropertiesPlantationsMiningREITsClosed-End FundsExchange Traded FundsStatutory/RegulatoryNot-for-ProfitOthersOther Industry*Contact Person*Address* Address Line 1 Address Line 2 City State Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Organisation Email Contact* TelephoneFaxNumber of Participants*12345Participant 1 DetailsSalutation*Designation*Given Name*Family Name*Email 1* Participant 2 DetailsSalutation*Designation*Given Name*Family Name*Email 2* Participant 3 DetailsSalutation*Designation*Given Name*Family Name*Email 3* Participant 4 DetailsSalutation*Designation*Given Name*Family Name*Email 4* Participant 5 DetailsSalutation*Designation*Given Name*Family Name*Email 5* Fees PayableTotal Fees RM 0.00 Payment Method*E-paymentChequePayment Made?*NoYesUpload payment receipt?*NoYesReceipt*Accepted file types: jpg, gif, png, pdf.PDPA Consent FormI hereby declare that I have given my consent to the processing of my personal data in accordance with the Notice under the Personal Data Protection Act 2010 and understand the terms and conditions herein. NOTICE UNDER THE PERSONAL DATA PROTECTION ACT 2010 The Personal Data Protection Act 2010 (hereinafter referred to as the “PDPA”), which regulates the processing of personal data in commercial transactions, applies to the Malaysian Alliance of Corporate Directors (hereinafter referred to as “MACD”, “our”, “us” or “we”). For the purpose of this written notice, the terms “personal data” and “processing” shall have the meaning prescribed in the PDPA. 1. This written notice serves to inform you that your personal data is being processed by or on behalf of MACD. 2. The personal data processed by us may include your name, national registration identity card no. (NRIC no.), contact number, address, email address, designation, company name, and all other details provided by you in the documents as prescribed in paragraph 4 of this notice. 3. We are processing your personal data, including any additional information you may subsequently provide, for the following purposes (“Purposes”): Administer and conduct MACD training programmes, events, MACD membership, and related activities, etc; Administer and design training programmes and events Provide services and support to MACD members Provide services in relation to our training programmes, consultancy services and related activities Provide you with information and/or latest updates on our training programmes and related membership activities Invite your participation in MACD membership, events and activities Invite your participation in our networking activities via social media invitations; and Respond to all your queries and emails 4. Your personal data is and will be collected from you and/or from the information you have provided on the website, your emails, all forms associated with training, membership programmes and events including the programme registration forms and membership application forms. 5. You may access and request for correction of your personal data and to contact us with any enquiries or complaints in respect of your personal data as follows: Mailing address: Malaysian Alliance of Corporate Directors Unit 02-03, Block F, Phileo Damansara 1 9 Jalan 16/11, Off Jalan Damansara, 46350 Kuala Lumpur, Malaysia E-mail address: email@example.com Phone Number: +60(3) 7490 4121 Mobile Number: +60(16) 980 0857 +60(12) 278-5560 Designation of contact person: Manager, Membership In accordance with the PDPA: We may charge a prescribed fee for processing your request for access or correction of your personal data; and We may refuse to comply with your request for access or correction to your personal data and if we refuse to comply with such request, we will inform you of our refusal and reason for our refusal. 6. Your personal data may be disclosed to parties such as but not limited to banks, auditors, governmental departments and/or agencies, regulatory and/or statutory bodies, business partners, service providers and any such third party requested or authorised by you for any of the above Purposes or any other purpose for which your personal data was to be disclosed at the time of its collection or any other purpose directly related to any of the above Purposes. 7. If you fail to supply to us the above personal data, we may not be able to process your personal data for any of the above Purposes. 8. Your personal data may be transferred to a place outside Malaysia. 9. You are responsible for ensuring that the personal data you provide us is accurate, complete and not misleading and that such personal data is kept up to date. 10. We may request your assistance to procure the consent of third parties whose personal data is provided by you to us and you agree to use your best endeavours to do so. By submitting this registration form, I hereby declare that I have given my consent to the processing of my personal data in accordance to PDPA 2010. This iframe contains the logic required to handle AJAX powered Gravity Forms.