Registration Form - Malaysian Water Association.

REGISTRATION FORM(Registration Deadline: 6 August 2012)MWA-ORGANISED TECHNICAL TOUR TOIWA WORLD WATER CONGRESS & EXHIBITION 2012, BUSAN, KOREA(9 DAYS/7 NIGHTS)15 TO 23 SEPTEMBER 2012To:The Tour OrganiserIWA World Water Congress 2012 BusanThe Malaysian Water AssociationNo. 24, 2 nd Floor, Jalan Sri Hartamas 8, Taman Sri Hartamas50480 Kuala LumpurAdvance-Registration via FAX: 03 6201 5801/E-mail: rubby@malaysianwater.org.myTel: 03 6201 2250/9521 (Rubby Mahmod/Asni Abdullah)NO. PARTICULARS UNIT AMOUNT1. REGISTERED DELEGATE RM RMA.i.CONFERENCE REGISTRATION FEESLIC IWA Member (Membership No: …...............……)Regular (€600)LIC (Non-IWA Member )Regular (€700)Notes: LIC – Low Income CountryExchange rate: Euro 1.00 to RM 4.202,520.002,940.00B.i.ii.SOCIAL FUNCTION TICKETS (optional):IWA Project Innovations Awards Ceremony & Dinner (€90)Gala Dinner (extra ticket) - (€125)378.00525.00C.i.ii.FLIGHT, HOTEL & GROUND ARRANGEMENTSReturn group ECONOMY CLASS air ticket, airport taxes(both ways) & fuel surcharge, hotel accommodation onTWIN SHARING, transfer and meals as specified.Return group BUSINESS CLASS air ticket, airport taxes(both ways) & fuel surcharge, hotel accommodation onTWIN SHARING, transfer and meals as specified.9,690.0015,859.002. EXTRA COSTS PER PERSON (subject to availability) RM RMA.B.TRAVEL INSURANCE (6 – 10 DAYS)SINGLE ROOM SUPPLEMENT54.003,500.00TOTAL AMOUNT IN RINGGIT MALAYSIANNote:For details, please refer to Terms & Conditions enclosed.Page 1/2

REGISTRATION FORM(Registration Deadline: 6 August 2012)MWA-ORGANISED TECHNICAL TOUR TOIWA WORLD WATER CONGRESS & EXHIBITION 2012, BUSAN, KOREA(9 DAYS/7 NIGHTS)15 TO 23 SEPTEMBER 2012DELEGATE DETAILS (please circle/state where applicable)Family Name _____________________________________________________ Prof/Dr/Mr./Ms./Mrs.First Name (for badge) ___________________________________________________ Male/FemalePosition in Organisation ____________________________________ Date of birth ____/____/_____Organisation ______________________________________________________________________Mailing Address ____________________________________________________________________________________________________________________________________________________Nationality ________________________________ Passport No. ___________________________Telephone ___________________ Mobile No. ___________________ Fax ________________Email address for confirmation of registration ____________________________________________IWA Membership No. _________________________Accompanying Person ______________________________________________________________PROFESSIONAL PARTICULARS (please tick ONE only for each category)A. Type of organisation B. Primary work role C. EducationConsultant/Contractor Administrative role PhDEducation institution Engineer/Technical PhD studentGovernment HR Master degreeLarge water using industry Management role Bachelor degreeManufacturer/Supplier Policy advisor Undergraduate studentNGO Product development Other (please specify)RegulatorResearcherResearch/Analytical labSales & MarketingUtilityOther (please specify)ScientistStudentOther (please specify)PAYMENTS (please submit latest by 13 August 2012)I am/ We are pleased to confirm *my/our participation to the above-mentioned tour and encloseherewith the payment, cheque no. ______________________ amounting RM_________________(including commission for outstation cheques).I/We have read and agreed to the terms and conditions of tour of The Malaysian Water Association.All cheques are to be made payable to: THE MALAYSIAN WATER ASSOCIATION………………………………………………Authorised signatureDate & Org. chopLiaison/contact person: _____________________________________________Designation: ______________________________________________________Tel/Mobile: ____________________________ Fax: _______________________Email: ___________________________________________________________Page 2/2