Registration Formconference

Registration FormConference

Your details:
Title / Mr. Ms. Mrs. Dr. Professor Others ______
Last Name
First Name
Full name
< Name to appear in the
“Certificate of Participation” >
Position in the Company
Your Job Function / Management
(CEO, Director, President, etc)
Head of Department
(Engineering, Services, etc)
Project Management / Consultant
Engineering
Procurement
Sales / System Programming
System Integration
Others______
Telephone / Email
Your company details:
Company
Address
Country / Postal Code
Industry / Chemical/ Petrochemical
Cement
Brewery
F&B / Glass
O&G
Palm Oil
Pharma / Solar
Steel
Water & Waste Water
Others ______
Category / End-user
Engineering Consultant
EPC/Main Contractor / OEM
System Integrator
Siemens Solution Partner
Registration
Full Conference Package
(With Lodging at Shangri-la) / Conference fee: Euro400

Complimentary access to all conference sessions
Complimentary Meals during the event
Complimentary passes to all Networking Events
Cost of Shangri-la hotel accommodations in an Executive Room for arrival on Tuesday, 06 September and departing on Friday, 09 September based on Single/Double occupancy

Note: If you choose to arrive after the 06th or depart prior to the 9th, the registration fee remains the same.
Your Room Preference / Smoking
Non-smoking / Single
Double / *With airport pick-up
* Charge to the guest account
Without airport pick-up
[ ] Standard Conference Package (Without Lodging) / Conference fee: Euro100
Complimentaryto the first 100 registrations

Complimentary access to all conference sessions
Complimentary Meals during the event
Complimentary passes to all Networking Events

Note: If you choose to arrive after the 06th or depart prior to the 9th, the registration fee remains the same.

Expected Date/Time of Arrival (Day/Month/Year): Flight:

Expected Date/Time of Departure (Day/Month/Year): Flight:

Do you have any special dietary restrictions? What are those?

Do you drink alcoholic beverages? Yes No

How did you learn about this event? / Siemens Account Manager
Siemens Newsletter
Siemens website / Siemens Partner
e-Newsletter
Trade magazines / Colleague
Invitation
Please select your primary interest?
(Select All that Apply) / Solution for Brewery
Solution for Cement
Solution for Chemical/Petrochem
Solution for F&B
Solution for Oil and Gas
Solution for Palm Oil
Solution for Pharma
Solution for Semicon
Solution for Solar/Glass
Solution for Water & Waste Water
Advanced Engineering System
Advanced Process Control
Advanced Process Library
Asset Management / Energy Efficiency
Engineering
Process Safety
Plant Security
Batch Automation
Burner Management System
Fieldbus Technology
Gas Metering
Hazardous Area Installation
Lifecycle Engineering
MIS/MES
Partial Stroke Test
Route Control
Telecontrol

Do you plan to attend the following networking events? Yes (Select All that Apply) No

Tuesday night, 06 September 2011
Welcome and Management Reception
Attire: Formal Business
Venue: Sabah Ballroom / Wednesday night, 07 September 2011
Siemens User Community Night
Attire: Business Casual
Venue: TBA
Thursday night, 08 September 2011
Farewell Dinner
Attire: Business Casual
Venue: Sabah Ballroom / No, I’m not attending the Networking Nights
Send me event updates via e-mail
(Recommended)
We will send you latest information aboutthe topics,
speakers, networking nights, rooms and others.
Cancellation/Change Policy:

Prior to 30 June, 2011, registration fees will be refunded in full
Cancellations will not be eligible for refund from 01 July 2011 onwards; however, substitution of a delegate from the same company will be permitted and must be communicated to

I confirm to attend the SPAESSEASummit by signing and returning this form:

Your name / Your Signature / Date