Delegate registration form

We request you to fill up all the fields. Complete this form and send with payment to:

India Semiconductor Association

UNI Building, 4th Floor, Millers Tank Bund Road, Bangalore 560 052 India

Please use separate forms for each delegate from your company. To request for one-on-one meetings please mail us at

Delegate details

First name

Last name

Job title/ designation

E-mail

Position (mark relevant)

Select your position by highlighting the necessary cell. Example Indian business leader
Indian business leader / Media professional / Human resource professional
Global business leader / Indian technology leader / Academic institution
Market analyst / researcher / Global technology leader / Any other (please specify)
Venture capitalist / investor / Government official

Company details

Name

Address

City Zip / postal code

State/ province Country

Telephone

Facsimile

Company website

Company type

ISA Member Non member

Select your company type by highlighting the necessary cell. Example EDA company

Indian semiconductor corporation / India head quartered semiconductor & service company
Public sector semiconductor company / Multinational semiconductor/ services company
EDA company / Semiconductor IP provider
Embedded semiconductor software company / TAPP service provider
Academic institution / Companies with interest in & plans for India
Investor community / Venture capitalist / Media

Delegate fees

ISA members / ISA non-members / CEHA, ELCINA, FSA, MIDAS, SEMI, TSIA members
Before Dec 15, 2007 / INR 13000 / USD 350 / INR 16000 / USD 435 / INR 14500 / USD 390
After Dec 15, 2007 / INR 16000 / USD 435 / INR 19000 / USD 515 / INR 17000 / USD 460

Inclusive of all taxes

Payment details

Through Cheque/ DD drawn in favor of “ISA Vision Summit” payable at Bangalore, India

Cheque/ DD number drawn on

Dated for INR

50% refund for cancellation before Jan 31, 2008. No refunds thereafter.

Wire transfer details

Account number where funds should be transferred:

3615 2559

Further credit to:

10461011000538

ISA VISION SUMMIT

MG Road, Bangalore branch

Currency:

US Dollar

US Bank through which funds should be transferred:

Citibank NA

111 Wall Street

18th floor,

New York 10043 U.S.A

SWIFT code:

CITIUS33

FedWire ABA routing number:

021000089

Remittance instructions:

Please pay to Citibank NA, 111 Wall Street, 18th Floor, New York 10043 USA Sum of USD...... For further credit to account no. 3615 2559 of International Banking Division, Oriental Bank Of Commerce, New Delhi India for further credit to account no. CA 10461010182030 of India Semiconductor Association being maintained with their Bangalore branch at M.G. road, Bangalore - 560 001 India.