REGISTRATION FORM

Strategic Electronics Summit 2012

26th & 27th July, 2012, Bengaluru

I / We wish to participate in SES 2012:

As a Conference Delegate As an exhibitor in the Mini-Exhibition As a sponsor

The details of participation are given below

v  Registration for the Conference

Delegate Name Designation Email ID

1.______

2.______

Conference Delegate Fees*:

Delegate fees for 2 days / Delegate fees for 1 day
ELCINA & ISA Members / INR 7,500 / INR 4,000
Non-Members / INR 9,500 / INR 5,000

Rates are inclusive of Service Tax @12.36% *(10% discount for 3 or more delegates of the same organization)

v  Stall Booking

Stall Size / For ELCINA & ISA Members / Non-Members / Please Tick
6 sq mtr. (3m X 2m) / INR 45,000 / INR 54,000 /
9 sq mtr. (3m X 3m) / INR 60,000 / INR 72,000 /
12 sq mtr. (3m X 4m) / INR 80,000 / INR 95,000 /

Rates are inclusive of Service Tax @12.36%

v  Sponsorship

Sponsorship Category / Please Tick
Platinum / INR 550,000 /
Gold / INR 250,000 /
Silver / INR 125,000 /
(Other sponsorship opportunities available on request)

Rates are inclusive of Service Tax @12.36%

v  Company Details :

Name & Designation ______

Company Name ______

Address ______

Phone / Mobile No. ______Email ID ______

Payment Details* DD / Cheque no. ______Dt. ______of (Bank) ______for Rs.______

Date ______Signature ______

* Payment by at par cheque / DD favouring “ELCINA ELECTRONIC INDUSTRIES ASSOCIATION OF INDIA” payable at New Delhi OR “INDIA SEMICONDUCTOR ASSOCIATION” Payable at Bangalore

Please send the Response form along with the payment to either of the addresses given below

ELCINA Electronic Industries Association of India
ELCINA House, 422 Okhla Indl. Estate Phase III
New Delhi – 110020, India
Tel: +91 11 26924597, 26928053; Fax: 26923440
E-mail: ; URL: www.elcina.com / India Semiconductor Association
UNI Building, Millers Tank Bund Road
Bangalore - 560 052, India
Tel: +91 80 4147 3250; Fax: +91 80 4122 1866
Email: URL: www.isaonline.org

(Service Tax Registration No. AAATE0201DST001)