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CONFERENCES FEES Conference Registration Fees RM 1600.00 Post-conference: Leading with Questions RM 1200.00 *Please Tick the Appropriate Box () *Employers who are registered with PSMB are to claim for airfare and daily allowance for 3 day(s) inclusive of the day before the conference. Pre-event: Coaches Networking Session (CNS) on 5 April 2017 Time: 7.30 -9.30 PM Yes No *CALC participants only PLEASE REGISTER THE FOLLOWING PARTICIPANTS No. Participants Details Email Gender Distance To Conference Location Meal Preference 1. Name: I/C No. / Passport No.: Designation: Male Female > 70 km < 70 km Vegetarian Non-Vegetarian 2. Name: I/C No. / Passport No.: Designation: Male Female > 70 km < 70 km Vegetarian Non-Vegetarian 3. Name: I/C No. / Passport No.: Designation: Male Female > 70 km < 70 km Vegetarian Non-Vegetarian Note : 1) Please note that all fields are mandatory. 2) Please use a separate sheet if you are sending more than 3 participants AUTHORIZATION FOR LEVY DEDUCTION FOR HRDF REGISTERED EMPLOYER PAYMENT INFORMATION ( TO BE FILLED BY NON-HRDF REGISTER EMPLOYER) I declare that the participants listed above are employers of our company. I, …………………………………….. (Name) here by agree that the conference fees amounting to RM…………… (Ringgit Malaysia : ……………………………………….) is to be debited from our levy account, in the event the above-mentioned participants fail to attend, PSMB reserves the right to debit the above fee. Signature: Date : Name : MY CoID : ccccccccc Designation: *(Chairman/General Manager/Manager/ HR Executives) *Delete where inapplicable Organization stamp: Payment Instructions 1. Conference fee must be paid in advance prior to the event 2. Payment via cheque should be crossed and made payable to “WIAL Affiliate (Malaysia) Sdn Bhd”. 3. Payment must be transfer to MAYBANK account number 514347616418. 4. Registration form must be submitted together with proof of payment. 5. For Overseas delegation please email us for payment arrangement. Payment Details ( Please Specify) Cheque Number & Bank ________________________ Cash (RM)____________________________________ Note: Confirmation of registration is upon received or cheque clearance SUBSTITUTION AND SUBMISSION OF REGISTRATION FORM PLEASE EMAIL OR FAX THIS FORM TO : o Only allowed before the issuance of confirmation letter and request must be made via email or fax to the organizer before 15 March 2017 o Any changes after the deadlines will not be entertained o Acceptance will be on a first come first serve basis o Please submit the registration forms to our WRC Committee. For further enquiry address them to ([email protected]) WIAL AFFILIATE (MALAYSIA) SDN BHD. No. 10-2-1 Jalan Medan Putra 3, Medan Putra Business Centre, 52200 Kuala Lumpur FAX : +603 6274 2953 EMAIL : [email protected] ORGANIZATION DETAILS Contact Person Organization Address Telephone City Mobile Phone State Fax Postcode Email Country Track Preferences for Participants TRACK A c Session 1 c Session 2 c Session 3 TRACK B c Session 1 c Session 2 c Session 3 TRACK C c Session 1 c Session 2 c Session 3

WRC HRDF Form 9th Febwialmalaysia.com/wp-content/uploads/2016/11/WRC-HRDF-Form-9th-Feb.pdf3 Mr. Peter Cauwelier Team Psychological Safety – what Google discovered about high performance

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Page 1: WRC HRDF Form 9th Febwialmalaysia.com/wp-content/uploads/2016/11/WRC-HRDF-Form-9th-Feb.pdf3 Mr. Peter Cauwelier Team Psychological Safety – what Google discovered about high performance

CONFERENCESFEESConferenceRegistrationFees� RM1600.00Post-conference:LeadingwithQuestions� RM1200.00

*PleaseTicktheAppropriateBox(√)*EmployerswhoareregisteredwithPSMBaretoclaimforairfareanddailyallowancefor3day(s)inclusiveofthedaybeforetheconference.

Pre-event:CoachesNetworkingSession(CNS)on5April2017Time:7.30-9.30PM� Yes� No*CALCparticipantsonly

PLEASEREGISTERTHEFOLLOWINGPARTICIPANTSNo. ParticipantsDetails Email Gender DistanceToConference

LocationMealPreference

1. Name:I/CNo./PassportNo.:Designation:

� Male� Female

� >70km� <70km

� Vegetarian� Non-Vegetarian

2. Name:I/CNo./PassportNo.:Designation:

� Male� Female

� >70km� <70km

� Vegetarian� Non-Vegetarian

3. Name:I/CNo./PassportNo.:Designation:

� Male� Female

� >70km� <70km

� Vegetarian� Non-Vegetarian

Note:1)Pleasenotethatallfieldsaremandatory.2)Pleaseuseaseparatesheetifyouaresendingmorethan3participants

AUTHORIZATIONFORLEVYDEDUCTIONFORHRDFREGISTEREDEMPLOYER PAYMENTINFORMATION(TOBEFILLEDBYNON-HRDFREGISTEREMPLOYER)Ideclarethattheparticipantslistedaboveareemployersofourcompany.I,……………………………………..(Name)herebyagreethattheconferencefeesamountingtoRM……………(RinggitMalaysia:……………………………………….)istobedebitedfromourlevyaccount,intheeventtheabove-mentionedparticipantsfailtoattend,PSMBreservestherighttodebittheabovefee.Signature:Date:Name:MYCoID:ccccccccc Designation: *(Chairman/GeneralManager/Manager/HRExecutives) *DeletewhereinapplicableOrganizationstamp:

PaymentInstructions1. Conferencefeemustbepaidinadvancepriortotheevent2. Paymentviachequeshouldbecrossedandmadepayableto“WIALAffiliate

(Malaysia)SdnBhd”.3. PaymentmustbetransfertoMAYBANKaccountnumber514347616418.4. Registrationformmustbesubmittedtogetherwithproofofpayment.5. ForOverseasdelegationpleaseemailusforpaymentarrangement.

PaymentDetails(PleaseSpecify)

� ChequeNumber&Bank________________________� Cash(RM)____________________________________

Note:Confirmationofregistrationisuponreceivedorchequeclearance

SUBSTITUTIONANDSUBMISSIONOFREGISTRATIONFORM PLEASEEMAILORFAXTHISFORMTO:o Onlyallowedbeforetheissuanceofconfirmationletterand

requestmustbemadeviaemailorfaxtotheorganizerbefore15March2017

o Anychangesafterthedeadlineswillnotbeentertainedo Acceptancewillbeonafirstcomefirstservebasiso PleasesubmittheregistrationformstoourWRCCommittee.For

furtherenquiryaddressthemto([email protected])

WIALAFFILIATE(MALAYSIA)SDNBHD.No.10-2-1JalanMedanPutra3,MedanPutraBusinessCentre,52200KualaLumpurFAX:+60362742953EMAIL:[email protected]

ORGANIZATIONDETAILS

ContactPerson Organization Address Telephone City MobilePhone

State Fax Postcode Email Country

TrackPreferencesforParticipantsTRACKAc Session1c Session2c Session3

TRACKBc Session1c Session2c Session3

TRACKCc Session1c Session2c Session3

Page 2: WRC HRDF Form 9th Febwialmalaysia.com/wp-content/uploads/2016/11/WRC-HRDF-Form-9th-Feb.pdf3 Mr. Peter Cauwelier Team Psychological Safety – what Google discovered about high performance

MESSAGEFROMWRC2017CHAIRMAN

DearDelegates,

ItiswithgreatpleasurethatweinviteyoutoparticipateintheWIALRegionalConference2017(WRC2017)tobeheldatConcordeHotelinKualaLumpur,Malaysiafrom6thto7thApril2017.Therewillbepre-andpost-conferenceworkshopeventson5thand8thApril2017.

TheoverallthemeoftheConferenceis“ActionLearning:ThePerformanceChangerinAVUCAWorld”,withthe sub-theme, “Collaborate, Engage and Transform Leaders”. Our two days Conferencewill focus on twoareas:discussionsonenhancingperformanceinpeopleandleadersthroughactionlearning,andexperiencingreallifeapplicationsofaforementioneddiscussions.

Concorde Hotel (http://kualalumpur.concordehotelsresorts.com) is in the heart of Kuala Lumpur, a city ofcontrastanddiversity.ItislessthanakilometerawayfromtheiconicPetronasTwinTowersandKualaLumpurTower.GettingaroundinKualaLumpurisrelativelyeasywithgoodtransportinfrastructure.

ShouldyouhavefurtherqueriesabouttheWIALRegionalConference(WRC),pleaseaddressthemtotheWRC2017committee([email protected]).

OnceagainIextendmywarmgreetingstoallattendeesandIbelieveyouwillenjoytheConferenceaswellasthebeautifulcityofKualaLumpur.

Thankyou.

Bestregards,

WilliamTeoM:+60163359744E:[email protected]:www.wialmalaysia.comOrganizingChairmanWRC2017

Page 3: WRC HRDF Form 9th Febwialmalaysia.com/wp-content/uploads/2016/11/WRC-HRDF-Form-9th-Feb.pdf3 Mr. Peter Cauwelier Team Psychological Safety – what Google discovered about high performance

Anoverviewoftheconference:

5Plenary,2activities,3breakouts,2networkingsessions.

PlenarySpeakers:

1 Dr.MichaelMarquadt(ALandItsImpactinLeadershipDevelopmentinaVUCAWorld)2 Dr.BeaCarson(TripleValueofActionLearning:BreakthroughSolution!TeamDevelopment!LeadershipDevelopment!)3 NadiaTan4 RonMcLuckie(CompleteBusinessTurnaroundCaseStudy)5 TanSriDr.Palan,Phd(AcceleratingLeadershipDevelopmentthroughActionLearning)

TRACKA

SESSION WORKSHOPSPEAKER

1 Dr.MichealMarquadtUnderstandandappreciatetheconceptsandbenefitsofActionLearningbyitsfounder.AfirsthandexperiencewatchingDr.MichaelMarquardtapplytheALprocess.

2 Mr.JayanWarrier

AppreciativeInquiry:AdialogicmodelofchangeleadershipinAVUCAWorld

3 Mr.RonMcLuckie

SeniorExecutiveActionLearning(SEAL)Programme

TRACKB

SESSION WORKSHOPSPEAKER

1 Dr.BeaCarsonVirtualActionLearning

2 Mr.ColinYeow

CognitiveCollaboration–WorkingSmarterinaVUCAEconomy

3 Mr.PeterCauwelierTeamPsychologicalSafety–whatGooglediscoveredabouthighperformanceteams.

TRACKC

SESSIONWORKSHOPSPEAKER

1 Mr.WaiKLeongTeamCoaching

2 Prof.Loredana

ActionLearning–asustainablebridgebetweenacademiaandindustry

3 Ms.FazKamaruddinTheAirAsiaActionLearningJourney

PRE-EVENT

CoachesNetworkingSession(CNS)–Connect,Create,Celebrate

5thApril2017

7.30pm–9.30pm@ConcordeHotelKualaLumpur

POSTEVENT(Additionalcost):

PostEventprogram–LWQ:LeadingWithQuestionsWIALApprovedCertificationprogramdeliveredbyDr.MarquardtforattendeeswhohavecompletedtheirFoundationandCALC(CertifiedActionLearningCoach).

Participantsofthis1daypost-conferenceprogramwillbecertifiedtodeliverthe“LeadingwithQuestions”program.Thefollowingresourceswillalsobemadeavailableattheend:

1. Ongoingaccesstothe3-hourpodcastofTrainersLwQ

2. The“LeadingwithQuestions”bookbyDr.MarquardtandtheLwQworkbook

3. CertificationforWIALCALCstoteachthiscourse

4. Accesstoslidesandworkbooksforuseandreprinting

5. CredentialslistedontheWIALwebsite

Date&Venue:8thApril2017:ConcordeHotelKualaLumpur

Forfurtherinformationregardingeachsession,pleasevisitwww.wialmalaysia.com