Office A, 15/F, Wing Cheong Commercial Building For internal reference

19-25 Jervois Street, Sheung Wan, Hong Kong Invoice Number:

Tel: (852) 3579 8079 Fax: (852) 3579 8080 Date:

CSR Asia Summit 2017 - Registration Form

26-27 September 2017, Amari Watergate Bangkok, Bangkok

Billing Information

Full Name:
(Person handling reg.) / Mr. Ms. Mrs. /
(First name) / (Last name)
Title / Position:
Company / Organisation:
Tel: (Include country codes) / Fax:
E-mail: / Website:
Address:
Country: / Industry:
Type of Organisation:
(Tick the appropriate box) / Company NGO / NPO Government Media
Individual Student Academic Others, please specify:


Delegate Information

Note: This form is only provided for up to 5 delegates. To register more than 5 delegates, please use additional forms.

Delegate Name: / Title / Position: / E-mail: / Tel:
1. / Mr. Ms. Mrs.
I am also attending these Pre-summit training: / Training 1 Training 2 Training 3
Training 4 Training 5 Training 6
2. / Mr. Ms. Mrs.
I am also attending these Pre-summit training: / Training 1 Training 2 Training 3
Training 4 Training 5 Training 6
3. / Mr. Ms. Mrs.
I am also attending these Pre-summit training: / Training 1 Training 2 Training 3
Training 4 Training 5 Training 6
4. / Mr. Ms. Mrs.
I am also attending these Pre-summit training: / Training 1 Training 2 Training 3
Training 4 Training 5 Training 6
5. / Mr. Ms. Mrs.
I am also attending these Pre-summit training: / Training 1 Training 2 Training 3
Training 4 Training 5 Training 6
Calculate Your Registration Fee /
Companies (per person) X quantity
/
NGOs/Students (per person) X quantity
Normal price /
USD 780 / THB 25,000 X
/
USD 546 / THB 18,000 X
Early bird rate (15% discount) - by 13 Aug /
USD 663 / THB 21,500 X
/
N/A
CSR Asia Strategic Partner(20% discount) /
USD 624 / THB 19,500 X
/
USD 546 / THB 18,000 X
Multiple participation package
(5-9 delegates – 20% discount) /
USD 624 / THB 19,500 X
/
N/A
Multiple participation package
(10 delegates and above – 30% discount) /
USD 546 / THB 18,000 X
/
N/A
Pre- summit training
(per session) /
USD 200 / THB 6,600 X
USD 170 / THB 5,600 X
(discount applies if you submit the registration by 13 Aug) /
USD 170 / THB 5,600 X

USD 150 / THB 5,000

(discount applies if you submit the registration by 13 Aug)

Total fee to pay (Include currency): Registration date:

Payment Method: Credit Card via PayPal Bank Transfer


Note: Upon receiving the registration form, an invoice will be issued together with the payment details.

PLEASE FAX THIS FORM TO: (852) 3579 8080 OR E-MAIL: