Registration Form SEMI SEA - Fundamentals of IC Packaging Seminar 2014 SEMI SEA – Fundamentals of IC Packaging Seminar 30-31 October 2014, MIDA HQ Building, Kuala Lumpur, Malaysia Upon completion, please email or fax to :SEMI Southeast Asia Email: [email protected] Fax No.: +65 6339.6637 Tel: +65 6339.6361 Attention : Ms Linda Tan Registration Profile (You must complete this section to receive an admission badge) Delegate Information 1. Please indicate your level of management or supervisory responsibilities. (Select one) *Salutation □ 01 Executive Management (Chairman, □ 02 Senior Management President, Chief, Managing Director, etc.) (Vice President / Director) □ 03 Other □ 04 Non-management Management □ 05 Other: (Staff / Professional) (Includes Trainee) 2. Please indicate your primary job function. (Select one) *First (Given) Name *Last (Family) Name □ 10 Executive Management / Board Member □ 32 Fabrication and Process Engineering □ 11 Facilities Engineering / Engineering Support □ 29 Human Resources Mgmt □ 16 Mfg. Engineering / Operations Mgmt. □ 34 Assembly / Packaging Engineering □ 17 Marketing, Sales, Business Developmt □ 12 Financial / Industrial Analyst □ 44 Product Management / Engineering □ 23 Quality Assurance & Test Engineering □ 28 Manufacturing and Production □ 27 Training □ 63 Design Engineering (incl. Software, □ 24 Research & Developmt Engineering □ 09 Environment, Health & Safety □ 99 Other: (Please describe) □ 22 Purchasing / Procurement □ 13 Government / Public Policy Systems, Test, Hardware) *Job Title 3. Which of the following best describes your company? (Select one) □ 210 PC / Consumer / Commercial *Company Name Electronics Manufacturer *Company Address *City State *Postal Code / Zip □ 220 Electronic Manufacturing Services (EMS) Provider □ 018 Photovoltaic / PV Cells and Modules Manufacturer □ 230 Electronics Distributor / Reseller □ 010 Semiconductor Device Manufacturer (IDM, foundry) □ 014 MEMS / MST / Micromachines Mfr □ 013 Fabless Semiconductor Manufacturer / Design House □ 012 Assembly & Test Services Provider □ 024 Semiconductor Equipmt Mfr □ 015 Flat Panel Display Manufacturer □ 041 Sub-systems / Components / Parts Manufacturer *Country *Tel (Country/Area Code/Number) Fax (Country/Area Code/Number) □ 016 LED / Optoelectronics / Photonics Manufacturer □ 036 Materials Supplier □ 085 R&D / Academic / Professional □ 050 Software – Electronic Design (EDA) / Silicon Intellectual Property (IP) □ 060 Software – Manufacturing/ Factory Automation □ 087 Media / Publication □ 073 Secondary Equipment and Services □ 090 Manufacturing Products / Consumables □ 070 Manufacturing Services and Consulting Organisations and Institutions □ 103 Construction / Construction Services □ 083 Finance / Investmt Pdts / Services □ 999 Other: (Please describe) □ 080 Professional Services and Consulting 4. Please indicate the technology areas or segment in which you are interested. (Select all that apply) □ 610 Semiconductors □ 617 Flexible / Printed Electronics □ 614 MEMS □ 618 Photovoltaic / PV □ 615 Flat Panel Display □ 619 Nano-electronics □ 616 LEDs/ Solid State Lighting □ 699 Other: (Please describe) *Mobile (Country/Area Code/Number) 5. Please select the product/technology categories of interest to you. (Select all that apply) MANUFACTURING EQUIPMENT MATERIALS SOFTWARE, OTHER PRODUCT AND SERVICES *Email (Receive confirmation letter by email) □ 024-00 Wafer Processing/Front-end Manufacturing Equipment Website □ 022-01 Thin Film Mfg Equipment □ 025-00 Test Equipment 30-31 October 2014 (Thurs – Fri) SEMI Member Non-Member □ □ RM1300 per pax RM1500 per pax □ 021-00 Assembly and Packaging Equip. □ 023-00 Inspection & Measurement/Metrology Products □ 026-00 Other Equipment □ 037-00 □ 036-00 □ 032-00 □ 033-00 Wafers and Substrates Process Materials Chemicals & Solids Gases □ 038-00 Test Materials □ 031-00 Assembly & Packaging Materials □ 039B-00 Other Materials □ 040-00 □ 045-00 □ 050-00 □ 063-00 Sub-Systems Component Parts & Accessories Factory Control Automation Software – Electronic Design/ Silicon Intellectual Property (IP) □ 070-00 Manufacturing Services or Consulting (incl. those service or consulting directly related to manufacturing) MANUFACTURING □ 210-00 Electronic Manufacturing Svcs □ 010-00 Semiconductor Device Mfg. (IDM, Foundries) □ 013-00 Fabless Semiconductor Mfr/ Design Services □ 012-00 Assembly & Test Services Special dietary Request Vegetarian □ 080-00 Business Services or Consulting □ 099-00 Other: (Please describe) □  Programmes and timings are subject to change without prior notice. Applicable to Malaysian companies only  Course fee will be debited from Human Resources Development Fund (HRDF) employer’s account.  Registered employers will be given 100% financial assistance (subject to terms and conditions). 6. Would you like to receive information on SEMICON Southeast Asia 2015 Penang ? (Select one) □ Yes □ No IMPORTANT:  Limited seats are available. Registration based on first-come-first-serve basis.  Upon receipt of registration, participant will receive email confirmation within a week.  Course fee must be made prior to the event to SEMI Singapore Pte Ltd via bank draft/cheque.  No cancellation is allowed once registered. Replacement of participant is permitted with authorisation letter. SEMI SEA - Fundamentals of IC Packaging Seminar 2014 PAYMENT INFORMATION FORM Please m ar k o n e o f t h e 3 p aym en t o p t io n s r ef er en ced b elo w an d co m p let e t h at r elat ed sect io n . Registration from individuals/companies with delinquent balances due SEMI will not be processed. No cancellation is allowed once registered. Replacement of participant is permitted with authorisation letter.  1. PAYMENT BY CHECK or INTERNATIONAL DRAFT (Singapore Dollars) Co m p an y Nam e:_________________________________________________________________ Make ch eck p ayab le t o SEMI Singapore Pte Ltd. (p lease in d icat e “Registration/Invoice No.” o n t h e r ever se sid e o f yo u r ch eck) an d sen d t o : SEMI Sin g ap o r e Pt e Lt d . 161 Laven d er St r eet #04-04 Sin g ap o r e 338750 Ph o n e: + 65.6339.6361 Fax: + 65.6339.6637  2. PAYMENT BY WIRE TRANSFER Wh en p ayin g w it h a w ir e t r an sf er , in st r u ct yo ur b an k t o r ef er en ce yo u r Nam e/ Co m p an y Nam e an d “Fundamentals of IC Packaging Seminar 2014” o n t h e b an k t r an sf er t o en su r e p r o p er cr ed it t o yo u r acco un t . It is t h e cu st o m er ’s r esp o n sib ilit y t o t r ack w ir e t r an sf er s w it h t h eir b an k in t h e even t SEMI d o es n o t r eceive t h e w ir e. Co m p an y Nam e: Or ig in at in g Ban k: Am o u n t o f Tr an sf er : Dat e o f Tr an sf er : Ban k Tr an sf er Rem it t an ce In f o r m at io n : Ben ef iciar y Nam e: Ban k Nam e: Ban k Ad d r ess: Ban k co d e: Br an ch Co d e: SEMI Sin g ap o r e Pt e Lt d St an d ar d Ch ar t er ed Ban k 6 Bat t er y Ro ad #01-00 Sin g ap o r e 049909 7144 001 Singapore SGD $ Acco u n t # 01-005-5128-9 Sw if t Co d e: SCBLSGSG U.S. USD $* Acco u n t # 01-740-2252-2 Sw if t Code: SCBLSGSG *Please use daily bank exchange rate on the date of payment for conversion to US$  3. PAYMENT BY CREDIT CARD (We accept VISA, Mastercard Only) CC Type: VISA / Mastercard (*delete) CC Holder Name: Expiry Date: CC #: CCV #: Amount: Signature:_____________________________________________ Please return this completed form with your registration form by fax to +65.6339.6637 (SEMI Singapore Office) or email to [email protected]