Conference Registration

DELEGATE DETAILS

Title

First Name

Last Name

Position

Email

Phone Number

Company Name

Company Address

Street Address

Street Address Line 2

City

State

Zip Code

Country

Partner Details

First Name

Last Name

Email

Phone/Mobile

Delegate

Please tick “✓” ( on the box )

Registration Fee

Plant Tour Group A - USD 45

Plant Tour Group B - USD 45

Plant Tour Group C - USD 45

Please tick “✓” ( on the box ) if you attend below event:

Welcome Party (Delegate)

Gala Dinner (Delegate)

Welcome Party (Partner)

Gala Dinner (Partner)

Please tick “✓” ( on the box ) for food preference:

Vegetarian

Pescatarian

EVENT

Delegate

X USD 1150 =

Golf Tournament

X USD 240 =

Partner

X USD 400 =

Plant Tour

X USD 45 =

APGGA / EGGA members code:

CONGRATULATIONS! YOU'RE ENTITLED TO A SPECIAL DISCOUNT! USD 100

Total

Total After Discount

Remarks :- Partner only allow to attend Welcome Party, Gala Dinner & Partner Program.

Required to Apply for a Visa

Yes

No

Please send me an invitation letter to apply for a visa. (if needed)

My personal data as follows :

Nationality:

Passport No:

Issue Date:

Expiry Date:

Issue Place:

Birth Date:

Birth Place:

First Name

Last Name

I will stay in Malaysia from:

Date

to

Date