Registration Formuser Speaker

Registration Formuser Speaker

Registration FormUser speaker

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
Presenters Pass
(User Speaker With Lodging) / Conference fee: COMPLIMENTARY
  • Priority access to all conference sessions
  • Complimentary Meals during the event
  • VIP pass to all Networking Events
  • Cost of hotel accommodations in a Superior Room, Single Occupancy for Arrival on Tuesday, 18 August and Departure on Friday, 21 August. Additional room nights, other room requests & hotel transfer will be chargeable to personal account.

Your Room Preference / Smoking
Non-smoking / Single
Double
* Charge to the guest account / *With airport pick-up
* Charge to the guest account
Without airport pick-up

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

Wednesday night, 19 August 2015
Siemens User Community Night
Attire: Business Casual / Thursday night, 20 August 2015
Farewell Dinner
Attire: Business Casual
No, I’m not attending the Networking Nights / Send me event updates via e-mail
(Recommended)
We will send you latest information about the topics,
speakers, networking nights, rooms and others.
Your topic/presentation details:
Topic
Abstract
Who is your Siemens contact? / Name Country

I confirm to attend the SPACe2015 by signing and returning this form:

Your name / Your Signature / Date