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Conference Exhibition April 20-22 2017 April 21-22 2017 Mumbai, India REGISTRATION FORM PERSONAL DETAILS (Please Use BLOCK LETTERS) TITLE Mr. Mrs. Prof. Dr. Ms. Delegate's Full Name ....................................................................................................................................................................... Company Name .............................................................................................................................................................................. Address .......................................................................................................................................................................................... City ................................................................................................... Country ............................................................................... Phone No. ..........................................................................................Email .................................................................................. ASME MEMBERSHIP No (if applicable) How did you hear about this program ASME EMAIL ASME WEBSITE WORD OF MOUTH SOCIAL MEDIA MEDIA PARTNER OTHERS ................................. Have you attended IOGPC before ? YES NO 2009 2011 2013 2015 REGISTRATION DETAILS EARLY BIRDMEMBER* EARLY BIRD NON‐MEMBER* 16,000 18000 Above rates are inclusive of 15% service tax. Registration fee includes ‐ 2 days of technical presentations, reception, break, lunch (if applicable) for one attendee PAYMENT DETAILS 1. Bank Transfer Name of the Account Bank Name Account No. Bank Address IFSC Code SWIFT Code VECTO EDGE HDFC Bank 5020013449943 24/3, HDFC House, No.51, Kasturba Road, Banglore INDIA HDFC0000009 HDFCINBB 2. Cheque / Demand Draft in favour of "Vecto Edge" Payable at Bangalore Cheque / Draft No. ...................... Date .................................... Amount .................................................................................... Bank Name ............................................................................... Branch ...................................................................................... Date ................................ Signature..................................... General Conference Policy The non‐member fees include a one year membership to ASME Check program website for additional information www.asme.org/IOGPC Please send this Registration Form and Cheque/DD to the Conference Manager: CATAGORY USD INR TICK 240 270 ASME India Office B101, Surbacon Maple, Chikkanayakanahalli Road Near Dodakanelli Junction, Carmelaram Post, Bangalore 560035 Rakesh Kumar +91 9886396791 [email protected] Madhukar Sharma, [email protected] ASME Pipeline Systems Division ‐ US Office Kim Miceli, [email protected] www.vectoedge.com www.asme.org/events/iogpc MEMBER NON‐MEMBER 19,000 22,000 285 315 *Early Bird Registration ends on 1st February 3. Online registration and payment are available here: www.asme.org/events/iogpc/register

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Page 1: IOGPC 2017 REGISTRATION Sponsorship FORM new · Conference Exhibition April 20-22 2017 April 21-22 2017 Mumbai, India REGISTRATION FORM PERSONAL DETAILS (Please Use BLOCK LETTERS)TITLE

Conference ExhibitionApril 20-22 2017 April 21-22 2017

Mumbai, India

REGISTRATION FORMPERSONAL DETAILS (Please Use BLOCK LETTERS)

TITLE Mr. Mrs. Prof. Dr. Ms.

Delegate's Full Name .......................................................................................................................................................................

Company Name ..............................................................................................................................................................................

Address ..........................................................................................................................................................................................

City ................................................................................................... Country ...............................................................................

Phone No. ..........................................................................................Email ..................................................................................

ASME MEMBERSHIP No (if applicable)

How did you hear about this program

ASME EMAIL

ASME WEBSITE

WORD OF MOUTH

SOCIAL MEDIA

MEDIA PARTNER

OTHERS .................................

Have you attended IOGPC before ?

YES

NO

2009 2011 2013 2015

REGISTRATION DETAILS

EARLY BIRDMEMBER*

EARLY BIRD NON‐MEMBER*

16,000

18000

Above rates are inclusive of 15% service tax.

Registration fee includes ‐ 2 days of technical presentations, reception, break, lunch (if applicable) for one attendee

PAYMENT DETAILS

1. Bank Transfer

Name of the Account

Bank Name

Account No.

Bank Address

IFSC Code

SWIFT Code

VECTO EDGE

HDFC Bank

5020013449943

24/3, HDFC House, No.51,

Kasturba Road, Banglore INDIA

HDFC0000009

HDFCINBB

2. Cheque / Demand Draft in favour of

"Vecto Edge" Payable at Bangalore

Cheque / Draft No. ...................... Date ....................................

Amount ....................................................................................

Bank Name ...............................................................................

Branch ......................................................................................

Date ................................ Signature.....................................

General Conference Policy

The non‐member fees include a one year membership to ASME

Check program website for additional information www.asme.org/IOGPC

Please send this Registration Form and Cheque/DD to the Conference Manager:

CATAGORY USD INR TICK

240

270

ASME India Office

B101, Surbacon Maple, Chikkanayakanahalli RoadNear Dodakanelli Junction, Carmelaram Post,

Bangalore 560035

Rakesh Kumar +91 9886396791

[email protected] Madhukar Sharma, [email protected]

ASME Pipeline Systems Division ‐ US OfficeKim Miceli, [email protected]

www.vectoedge.comwww.asme.org/events/iogpc

MEMBER

NON‐MEMBER

19,000

22,000

285

315

*Early Bird Registration ends on 1st February

3. Online registration and payment are available here: www.asme.org/events/iogpc/register

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