Do You Plan to Attend the Following Networking Events? (Select All That Apply)

Registration Form Siemens

Your details:
Title / Mr. Ms. Mrs. Dr. Professor Others ______
Last Name
First Name
Full name
Position in the Company
Telephone / Email
Your company details:
Company
Address
Country / Postal Code
Siemens Department / VMM ASEAN
VMM HQ
Marketing and Promotions (MP) HQ
Sales
Others ______/ DF /PD ASEAN
Marketing Communication
Business Development
SIMATIC PCS 7 Promoter
Industry
(Skip this if not applicable) / Chemical/ Petrochemical
Cement
Brewery
F&B / Glass
O&G
Palm Oil
Pharma / Solar
Steel
Water & Waste Water
All Industries
Registration
Siemens Conference Package
(without Lodging) / Conference fee: Euro400
§  Complimentary access to all conference sessions
§  Complimentary Meals during the event
§  Complimentary passes to all Networking Events
Note: Note: If you choose to arrive after the 18th or depart prior to the 21th August, T2015, the conference fee remains the same.
*Please charge my conference fee of Euro400 to:
Org ID # ______Cost Center ______

Do you plan to attend the following networking events? (Select All that Apply)

Wednesday night, 19 August 2015
Siemens User Community Night
Attire: Business Casual / Thursday night, 20 August 2015
Farewell Dinner
Attire: Business Casual
No, I’m not attending the Networking Nights / Send me event updates via e-mail
(Recommended)
We will send you latest information about the topics,
speakers, networking nights, rooms and others.

Do you have any special dietary restrictions? What are those?

Do you drink alcoholic beverages? Yes No

Cancellation/Change Policy:

§  No Cancellation. No Refund; however, substitution will be permitted and must be communicated to

The organizer can arrange your hotel reservation

Do you want SPACe organizers to arrange your hotel booking? This will be charge to your account.

Yes, please arrange my hotel booking. Below are my details

No, thanks. I will arrange it myself.

Hotel details: TBA

Type of Room: Superior Room

Room Rate/Night: TBA

Single Occupancy

Your Room Preference / Smoking
Non-smoking / King Size Bed
Two Single Beds / With airport pick-up
Without airport pick-up

Expected Date/Time of Arrival (Day/Month/Year): Flight:

Expected Date/Time of Departure (Day/Month/Year): Flight:

I confirm to participate and agree with the SPACe 2015 Terms and Conditions by signing and returning this form:

Your name / Your Signature / Date