STEP 1: SELECT YOUR PACKAGE (please tick option)

FORUM KETAHANAN ENERGI NASIONAL

Register by 20th Aug 2016

(Domestic)

Register after 20th Aug 2016

(Domestic)

Regular Fee (Overseas)

Rp. 4.500.000,- Rp. 5.000.000,- Rp. 8.000.000,-

20% discount available for 3rd and subsequent delegates from the same company

Savings include Multiple Package & Early Booking Discounts. All discounts can only be applied at the time of registration and discounts cannot be combined apart from early booking discounts which are available to everyone. All discounts are subject to approval. We are happy to accept a replacement delegate for the whole event; however delegate passes cannot be split or shared between delegates under any circumstances. Please note the event fee does not include travel or hotel accommodation costs.

STEP 2: DELEGATE DETAILS (FOR EASE, ATTACH YOUR BUSINESS CARD)

1st Delegate Mr/Mrs/Ms

2nd Delegate Mr/Mrs/Ms

Job title Job title

Company Company

Address Address

Mobile Mobile

Email Email

3rd Delegate Mr/Mrs/Ms Booking Contact

Job title Job title

Company Company

Address Address

Mobile Mobile

Email Email

DELEGATE REGISTRATION FORM

Payment Policy: Payment is due in full at the time of registration. Full payment is mandatory for event attendance. Cancellations & Substitutions: Substitutions will be accepted at any time prior to the event. FKEN will not provide refunds for cancellations. For cancellations received in writing more than seven (7) days prior to the conference, you will receive a full credit to be used at another FKEN event for up to one year from the date of issuance. For cancellations received seven (7) days or less prior to an event (including day 7), no credits will be issued. In the event that FKEN cancels an event, a full credit will be credited to the delegate for use at another FKEN event. This credit is valid for one (1) year from the date of issuance. We reserve the right to change the venue and date of the event if required. FKEN is not responsible for any loss or damage as a result of a substitution, alteration or cancellation / postponement of an event. FKEN will assume no liability whatsoever in the event this event is cancelled, rescheduled or postponed due to a fortuitous event, Act of God, unforeseen occurrence or any other event that renders performance of this event impracticable or impossible. For purpose of this clause, a fortuitous event shall include, but not be limited to: war, fire, labor strike, extreme weather or other emergencies. Program Change Policy: Please note that speakers and topics were confirmed at the time of publishing; however circumstances beyond the control of the organizers may necessitate substitutions, alterations or cancellations of the speakers and/or topics. As such, FKEN reserves the right to alter or modify the advertised speakers and/or topics if necessary. Any substitutions or alterations will be updated on our web page as soon as possible.

Please use this form as our request for payment. Your participation is guaranteed only when full payment has been received, which must be received before the event. For payment by Bank Transfer to: Bank Name : Bank BRI Bank Account: 059601000124568 Account Name: Forum Ketahanan Energi Nasional For further information on payment details please call +62 21 2279 1107

4 EASY WAY TO REGISTER Phone : +62 21 2279 1107 Fax: +62 21 2279 1107 Email: register@forum-ken.com Web: www.forum-ken.com

EVENT DETAILS Thursday, 8 September 2016. 09.00 – 17.00 Puri Agung Convention, Grand Sahid Jaya Hotel Jakarta.