Application Form

Application Form

For further details, visit ICOPM website at icopm.mpob.gov.my

Note: * indicates mandatory field

Personal Particulars

Name *
Organisation *
Address


Postcode	City
State (applicable for address in Malaysia)	Country
Telephone No.	Cell No.
	Facsimile No.
E-mail *	Alternative E-mail*	*(e.g.: @yahoo, @gmail, @hotmail)*

Alternative Contact for the Team

Name *
Organisation *
Address


Postcode	City
State (applicable for address in Malaysia)	Country
Telephone No.	Facsimile No.
	Cell No.
E-mail *	Alternative E-mail *	*(e.g.: @yahoo, @gmail, @hotmail)*

Product/Invention

Product/Invention Title
Category *	Harvesting Technology Loose Fruit Collection Technology Fresh Fruit Bunches Evacuation Technology
Is your invention protected by a patent?	Yes No
If not, what kind of protection does your invention have?

Registration Fee & Form of Payment

Registration Fee	Participation Fee paid in Ringgit Malaysia (RM) Participation Fee paid in US Dollar (USD)
Charge	0.00
Total Charges to be Paid	0.00
Payment Instructions	Payment by cheque will be sent to MPOB Payment by Telegraphic Transfer (T/T) to MPOB Please charge the following card (see instruction below)
Credit Card Instruction Please print out the Registration Form and sign on the Cardholder signature box, enclose photocopy of credit card and provide credit card information as follows:
Name as printed on card
Credit Card Number
Type of Card	Mastercard Visa
Expiry Date
Cardholder Signature

Yes No

I/We undestood and agreed to abide all the International Competition on Oil Palm Mechanisation (ICOPM 3) rules and regulations.