Energy Delegation to the USA

Defence, AerospacePower/

Energy delegation to the USA

August 20 – September 1, 2017

REGISTRATION FORM

First Name: ………………………………………………………………………………………………………..

Last Name: …………………………………………………………………………………………………………

Designation: ………………………………………………………………………………………………………

Organization: ……………………………………………………………………………………………………..

Address 1: ………………………………………………………………………………………………………….

Address 2: ……………………………………………………………………………………………………..…..

City: …………………………………………State: …………………………………………………….………..

Country: ……………………………………Postal Code:…………………………………….……………..

Phone: ………………………………………Mobile……………………………….…………………………..

Fax: ……………………………………………Email……………………………………………………………..

Passport Number:……………………………………Passport Expiry Date…………….…………..

PAN Card Number:…………………………………………………………………………………………..

Holding US Visa: Yes…………………………No……………………

Applied before: ………………………………………….

REGISTRATION DETAILS

*Service Tax 15% extra

Kindly Note:

The above fee includes:

• Administration of

1. Delegates directory
2. Delegate badge
3. Arrangements for B2B and B2G interaction
4. Administrative Costs

Note:

1. In case delegation is cancelled by IACC then Registration Fee will be refunded after deduction of actual cost, if any.
2. In case of cancelation by the delegate, the refund would be:

a)75% prior to 45 days of the delegation date;

b)25% prior to 30 days of the delegation date;

c)No refund if less than 30 days of the delegation date.

1. Detailed expenditure for entire delegation will be shared once we receive required confirmation from member community.
2. 10% Discount for 3 or more registration from the same company.
3. Registration on“first come first served” basis.
4. IACC reserves the right to cancel and or change the delegation process at any stage without assigning any reason.
5. IACC reserves the right to accept or reject any or all the applications received at its discretion, without assigning any reason whatsoever. Subject to the Chennai Jurisdiction.
6. Please kindly provide the following with the form:

1. Brief profile of your organization
2. Purpose of your visit with specific areas of business interests/collaboration that you are looking for:
3. Copy of PAN Card
4. Copy of Passport
5. 2 copies of recent passport size photos.

1. Last date for registration: 28thJune, 2017.

HOW TO REGISTER

Cheque payment:

Cheque to be prepared in favour of:

“Indo-American Chamber of Commerce”

and sent to the following address:

INDO AMERICAN CHAMBER OF COMMERCE

New No.6 (Old No.2), Seethammal Colony 1st Cross Street

Alwarpet, Chennai – 600 018.

OR

You may send the payment through wire-transfer.

Details are given below:

Date : ______Signature ______

Place: ______

(Please fill in this form and send it to following address. Or

Fax it on 044-24358391 or mail :

Use photocopies for additional registrations)

For any other information please contact