Please Complete This Form and Return to the INTERTANKO Oslo Office

Please complete this form and return to the INTERTANKO Oslo Office

·  For payment via credit card please fax: +47 2212 2641 or between 0900 - 1400 Norwegian time (GMT +2)

phone + 47 2212 2657 // + 47 2212 2687

·  For payment via bank transfer please use details below and confirm by email to:

·  Confirmation will be sent upon receipt of payment

DELEGATE INFORMATION
Capt./Mr./Mrs./Ms./Miss/Dr./Other (please state):
Family Name: / First Name:
Company Name: / Position:
Street Address:
City: / Postal Code: / Country:
Telephone: / Fax:
E-mail:
Required for confirmation
EVENT REGISTRATION
(please tick all that apply) / Members & Associate Members / Non Members
AGM Wednesday 29 May 1610 – 1700 / FREE
Annual Dinner Wednesday 29 May 1900 – 2400 / US$ 195 / US$ 299
For partner/spouse attending, please give name: / US$ 195 / US$ 299
Strategies for Survival High Level Seminar
Thursday 30 May 0900 - 1600 / US$ 295 / US$ 499
Associate Members’ Open Hour
Thursday 30 May 1600 - 1700 / FREE / FREE
Workshops Friday 31 May
(free for Members & Associate Members also attending Thursday’s Seminar) / US$ 149 / FREE / US$ 249
Chartering and Arbitration Workshop 0900 - 1600 / / /
Security in the Gulf of Guinea Workshop 0830 - 1200 / / /
Ballast Water Management Workshop 0830 - 1200 / / /
Energy Efficiency Workshop 0830 - 1200 / / /
Vetting Workshop 1245 - 1600
(free for those attending any of the Friday morning workshops) / / /
Dinner, Seminar and Workshop Package / US$ 450 / US$ 900
Please state any dietary requirements:
PAYMENT INFORMATION Note: All remittances must be free of bank charges & commissions
I have paid USD ______into INTERTANKO’s bank account
Account Name: INTERTANKO; Account No. 83960441497; IBAN: NO8483960441497; SWIFT CODE: HANDNOKK.
Bank Details: Handelsbanken A/S, Postboks 277 Skoyen, N-0212 Oslo, Norway
VISA / Mastercard / American Express* / Expiry date: / CVC Code:
Name on Card: / Card Number:
Signature:

* All transactions will be made in USD, with exception of American Express Credit Cards - these are charged in Norwegian Kroner at the rate prevailing on the day when the transaction is made.

** Cancellations need to be in writing addressed to . An administration fee of US$ 100 will be charged for cancellations received before 1 May 2013. Cancellations between 1 and 17 May will be liable for 50% of the total plus an administration fee of

US$ 75. Cancellations received after 17 May are non-refundable.