Registration Form NACE 2014 - Novan
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Transcript of Registration Form NACE 2014 - Novan
CONFERENCE REGISTRATION FORM
General Information on NACE International East Asia & Pacific Rim Conference & Expo 2014Event name: NACE International East Asia & Pacific Rim Conference & Expo 2014Venue: Bali Nusa Dua Convention CenterEvent Dates: September 2 4, 2014 : Conference and ExhibitionRegistration: Please kindly return the form registration as soon as possible by Email Print out this form and show the registration form on re-registration Please kindly checking 2 hour or a half hour before Participants will be recommended to arrive one day before the main eventGala Dinner Info : Gala dinner costs does not include the cost of registration
Mail completed form to: [email protected]
Participant Details:NACE member number: Non-member Technical Paper Presenter ***Last name (surname):Saputro*First name:Novan DwiNickname:*Company name:Joint Operation Body Pertamina - Petrochina East Java*Address:Jl. Lingkar Pertamina, desa Rahayu, Soko, Tuban*City:Tuban*State/province:East Java*ZIP/Postal code:62372 Country:Indonesia*Phone number:(0356) 811 911 Fax number:(0356) 811 955*E-mail address:[email protected]**Title of Technical Paper:
*Denotes a required field **Required Field for Technical Paper Presenter***Notes: If you a member of NACE, Please attach your ID member by scan or soft-copy.
Details of Your CompanyMY COMPANY IS A(N):THICK
Academia/R&D
Asset Owner/Operator X
Association Government/Regulatory Agency
Manufacturer/Supplier
Media/PR/Advertising Agency
Service Provider/Contractor
No Company Affiliation
UTILITIES:THICK
Coal
ElectricX
Gas DistributionX
Nuclear
Solar
Telecommunications
Water/WastewaterX
Wind
PRODUCTS I USE OR SELLTHICK
(Select all that apply):
AbrasivesX
AdhesivesX
Application EquipmentX
CoatingsX
ConcreteX
Data Recording and ManagementX
Equipment/SoftwareX
Inspection EquipmentX
InsulationX
Mechanical Equipment/MachineryX
Monitoring EquipmentX
Safety EquipmentX
Surface Preparation EquipmentX
Testing EquipmentX
Cathodic/Anodic ProtectionX
Chemical InhibitorsX
Linings MaterialsFerrousX
MaterialsNonferrousX
Maintenance/RehabilitationX
Metal FabricationX
OffshoreX
PRODUCTS I USE OR SELLTHICK
Agricultural Equipment
Chemical/PetrochemicalX
ElectronicsX
Food Processing
Home Appliances
Mining
Oil and Gas Exploration/ProductionX
Pulp & Paper
Refinery/Gas ProcessingX
INFRASTRUCTURE:THICK
Airports
Gas and Liquid PipelinesX
Hazardous Material Storage
Highways/Bridges
Railroads
Waterways and Ports
Other Infrastructure
TRANSPORTATION:THICK
Aerospace/Aircraft
Automotive/MotorX
Marine/Ships
Vehicle
Hazardous Material Transport
Railroad Cars
Other Transportation
PRODUCTS I USE OR SELLTHICK
(Select all that apply):
OnshoreX
Original EquipmentX
Rail Cars/Tank
Surface Preparation/BlastingX
Testing Services
TrainingX
Underground StorageX
Water DomesticX
Other/Company Function Not Listed
Materials Selection & DesignX
Measuring, Analyzing & ControllingX
InstrumentationX
Manufacturer Power/Energy DistributionX
Power/Energy GenerationX
Power/Energy TransmissionX
Trucks Refining/Gas ProcessingX
Laboratory/ResearchX
Ship Building
Water Industrial
Wastewater Domestic
Wastewater IndustrialX
Wind
GOVERNMENT:THICK
DoDMilitary
Nuclear Waste Storage
Other/Industry SegmentX
Not Listed
CONFERENCE REGISTRATION PAYMENTPlease clearly and completely fill out all pages of this registration form. No telephone registrations are accepted. Payment must be made in U.S. dollars or Indonesian Rupiahs, Registration will not be processed without payment. Registration and payment date determine price and must be received by Energy Nusantara, telephone registrations will be accepted.
Registration FeeRegistration CatagoriesPriceThick
NACE member conference registrationUSD 450
Non-NACE member conference registrationUSD 500
NACE member Student conference registrationUSD 250
Non-NACE member Student conference registration & Student PresenterUSD 250
Technical Paper PresenterUSD 400
Exhibition hall visitorFree
Function Tickets & Other FeesAmountThick
Gala Dinner (Individual Ticket)USD 250
Official Hotel PackageAmountThick
Melia Bali Hotel (Deluxe Garden Room) 4 Night Package Check in 1 Sept 2014 - Check Out 5 Sept 2014USD 670
Melia Bali Hotel (Deluxe Pool Room) 4 Night Package Check in 1 Sept 2014 - Check Out 5 Sept 2014USD 850
BNDCC Hotel (Deluxe Room) 4 Night Package Check in 1 Sept 2014 - Check Out 5 Sept 2014USD 430
Total payment in US$
Note: Conference Registration Fee Above does not include VAT (Value Added Tax), We will add the VAT tax in the invoice. Hotel Package Price include VAT Mandiri BankAccount Name: NACE IJS USD: 156-000-776841-1IDR: 156-000-776840-3SWIFT CODE: BMRIIDJAEmail: [email protected]
Signature & Company Stamp
NACE INTERNATIONAL EAST ASIA & PACIFIC RIM AREA CONFERENCE & EXPO 2014 Secretariat will send the invoice after receiving the completed registration form.
REGISTRATION & CANCELLATION POLICIESAll cancellations MUST BE SUBMITTED IN WRITING. If you cancel 35 DAYS PRIOR to the conference you will receive a refund of 50%. If you cancel from 30 DAYS to 3 DAYS PRIOR to the conference you will receive a refund of 10%. NO REFUNDS will be given 7 DAYS or less prior to the conference.
HOTEL RESERVATION FORMNACE International East Asia & Pacific Rim International Conference & Expo 20141 -5 September 2014
please complete the below form and return it to the Energy Nusantara, Email to, [email protected] The following rates will be valid for all delegates of NACE International East Asia & Pacific Rim International Conference & Expo 2014.
Name Company
Telephone Email
The Westin Resort Nusa Dua Hotel (*****)Single Double/Twin Sharing with_________ Premium USD 180.00 Premium USD 180.00
Melia Bali Hotel (*****)Single Double/Twin Sharing with_________ Premium USD 170.00 Premium USD 170.00
BNDCC Hotel (*****)Single Double/Twin Sharing with_________ Deluxe USD 120.00 Deluxe USD 120.00
Courtyard Marriot Hotel (****)Single Double/Twin Sharing with_________ Deluxe USD 135.00 Deluxe USD 135.00
Mercure Hotel (****)Single Double/Twin Sharing with_________ Deluxe USD 75.00 Deluxe USD 75.00
Santika Siligita Nusa Dua Hotel (***)Single Double/Twin Sharing with_________ Deluxe USD 70.00 Deluxe USD 70.00
Arrival Date Flight No Time
Departure Date Flight No Time All prices include 21 % tax & service and breakfast for 2 persons.
Term & Condition :1. Reservations must be guaranteed by cash or transfer to NACE IJS account.1. Final review 30 days prior to arrival the released period , any room required will be subject to room availability 1. Any cancellation 14 days prior to arrival or no show a one night cancellation fee will be charged.1. Any cancellation cause of force majeure e.g nature disaster, terrorist attack or political unrest allowed without penalty1. Any late check-out require until 18;00 will be 50% from the rate offer and After 6:00pm one night room charge will be apply. 1. Payment must be settled in cash or by money transfers to the following account number.
Thank you and we look forward to welcoming you