22-24 February 2012, Grand Hyatt Hotel, Nusa Dua Bali, Indonesia
Conserving Forests, Expanding Sustainable Palm Oil Production
Posted August 02' 2011 | 06.08



REGISTRATION FORM FOR PARTICIPANT


Please complete this form and fax or email back to: 
Fax: (62) 21 318 1315   Email : registration@icope-series.com  
Attn: Ms. Vira Permatasari & Maharti Rihana

Participants

Name    :  ____________________________________________
Job title :  ____________________________________________
Email     :  ____________________________________________

Name    :  ____________________________________________
Job title :  ____________________________________________
Email     :  ____________________________________________

Name    :  ____________________________________________
Job title :  ____________________________________________
Email     :  ____________________________________________

Company/Organization Info

Company : ___________________________________________
Address   : ___________________________________________
____________________________________________________
____________________________________________________
City:___________ Country:____________Postcode :__________
Ph:______________________ Fax: _______________________
Website   : ___________________________________________
Nature of Business:  ____________________________________


CONFERENCE FEE and PAYMENT METHOD


















Note:
  • US$ 1 = IDR 8500
  • Accommodation is not included in the conference fee.
  • Please Fax or Email proof of payment when paid

An amount of IDR__________________/US$__________________  (in Full Amount) have been transferred by wire to the bank account:
PT. Smart. Tbk.
Bank Internasional Indonesia (BII) Jakarta Thamrin Branch
Rupiah Account (IDR)        : 2-003-01404-6
US Dollar Account (US$)   : 2-003-03609-2
Swift code            : IBBKIDJA

on (DD/MM/YYYY)   ______________________________________

Contact Persons
Name    :  ____________________________________________
Ph         :  ____________________  Fax: ___________________
EMail     :  ____________________________________________


Terms and Conditions:

  • Payment closed at 11 February 2012, payment after the aforementioned date will be categorized as Walk In payment.
  • Request for substitutions are welcome. Please notify the secretariat at least 1 (one) week before the event.
  • Request for cancellations must be made in writing at least 3 (three) weeks before the event (31 January 2012). All cancellations will carry 25% administrative fee. Refund will be issued 2 weeks after the conference
  • No refund will be given for cancellations received after 31 January 2012. However, a complete set of conference papers will be sent to you.

Indemnity
The organizer reserves the right to make any changes or amendments to the program for reasons beyond its control. The organizer s shall endeavor to reschedule but the client hereby indemnifies and holds the organizer harmless from and against any and all costs, damages and expenses, including attorney fees, which are incurred by the client.



For further information, please contact:
Secretariat of ICOPE 2012
Plaza BII, Second Tower, 10th Floor Jalan MH Thamrin Kav 22 Jakarta 10350 ? Indonesia
Email : secretariat@icope-series.com   Website : http://www.icope-series.com
Phone : +(62) 21 3181 212, +(62) 21 3181 224      Fax : +(62) 21 3181 315



++Registration Form For Participant   [download]