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


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


(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

Registration Form NACE 2014 - Novan

Documents

Transcript of Registration Form NACE 2014 - Novan