AUGUST 18-20, 2015 GREATER COLUMBUS CONVENTION CENTER COLUMBUS, OHIO power-gennaturalgas.com 2015 REGISTRATION FORM Please Print First Name Last Name Title Organization Address 1 Address 2 City State Country Postal Code *Telephone *Fax Zip Email *Please include country and city code. Registration confirmation will be sent via e-mail, if an unique e-mail address is provided above. You may receive reminders and information about POWER-GEN International via e-mail. If you do not wish to receive other business-related third party email offers from PennWell, please check here. I want to start/renew my free digital subscription to Power Engineering magazine. Yes No Signature ______________________________________________________________ Date _________ TYPE OF COMPANY OR ORGANIZATION Business functions, product or service the company performs, NOT the industry it targets. 10 89 Oil/Gas Company - Integrated, State-Owned, Independent 02 Municipal Electric Utility 03 Rural Electric or Other Electric Cooperative 39 Other Public Electric Utility, including Federal, State or District Other industries (including Textile Mills, Coal & Petroleum Products, Rubber & Leather, Stone, Clay, Glass and Food & Kindred Products) onsulting/Engineering/Construction Company C engaged in projects or providing services for an oil and/or gas company 04 94 09 Independent Power Co., Unregulated Utility Subsidiary, Cogenerator or Small Power Producer Power Plants plus Service and Commercial Establishments 30 Contractor 19 Original Equipment Manufacturer (OEM) 50 Financial 26 Pulp & Paper 25 IT & Software Solution 60 Service/Supply 28 Chemicals and Allied Products 98 Other (please specify) __________________________ 65 Government/Library/Education 34 Fabricated Metal Products, Primary Metals & Mining _________________________________________________ 01 Investor-Owned Electric Utility 35 Machinery including Electrical & Electronic JOB FUNCTION Business functions, product or service the company performs, NOT the industry it targets. 02 General or Corporate Management (CEO,Pres, VP. Partner, Director,Manager, etc.) 07 Other Engineering 98 08 Operations Management _________________________________________________ Other (please specify) ___________________________ 03 04 Superintendent/Field/Professional/Foreman Engineering Management 10 Operations, including Maintenance 06 Engineering/Technical/Geoscience including Design, Systems and Planning 12 Purchasing/Consulting 11 Other Operations WHAT FORMS OF ENERGY ARE USED AT YOUR COMPANY OR WHAT FORM IS YOUR COMPANY INTERESTED IN? 01 Nuclear 05 Coal 10 02 Oil 06 Waste 11 03 Natural Gas 07 Wind 08 04 Hydro 08 Solar Bio Fuels Marine Hydrokinetics (MHK) Other (please specify) _____________ Choose one of four easy ways below to register for POWER-GEN Natural Gas: Fax: Direct: +1-918-831-9161 Toll-Free: 888-299-8057 Email: [email protected] Web: www.power-gennaturalgas.com Address: Power-Gen Natural Gas PennWell C&E Registration P.O. Box 973059 Dallas, TX 75397-3059 USA For questions, please call: Direct: +1-918-831-9160 Toll-Free: 888-299-8016 1. CONFERENCE FEES Conference fees include three day Conference, Keynote Session, Mega-sessions, Plenary Session, Exhibition, Exhibit Floor Receptions, Online Conference Proceedings and Delegate Lunches. Individual ❍ Paid by 7/18/15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $495 ❍ Paid after 7/18/15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $595 Government Agency ❍ Paid by 7/18/15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $350 ❍ Paid after 7/18/15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $375 International (Non-U.S. Residents) ❍ Paid by 7/18/15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $350 ❍ Paid after 7/18/15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $375 Single Day (Does not include conference proceedings) ❍ Paid by 7/18/15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300 ❍ Paid after 7/18/15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $350 Exhibitor Delegate (Must be exhibiting company of POWER-GEN Natural Gas 2015) ❍ Paid by 7/18/15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $260 Student (ID is required) ❍ Student. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $250 Gas/Power Industry Partner (Send UNLIMITED employees for one flat rate. Restrictions apply.)* ❍G as Producer___ / Pipeline___ / Processing___ (please make a selection) . . . . . $500 ❍ Power Generator. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $500 *R egistration is checked to confirm applicant is from an approved company in order to qualify for discount. 2. EXHIBITION ONLY Includes Exhibit Hall access, Keynote Session and Exhibit Floor Reception only. ❍ Exhibition Only. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $75 3. DELEGATE LUNCH TICKETS Tuesday and Wednesday Lunch is included in Delegate Registrations. ❍ Delegate Lunch Ticket Tuesday, August 18, 2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $40 ❍ Delegate Lunch Ticket Wednesday, August 19, 2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $40 4. ONLINE CONFERENCE PROCEEDINGS Only for those that are NOT registered as a Conference Delegate. Full Conference Registration includes the Online Conference Proceedings. ❍ Online Conference Proceedings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $195 For additional information regarding the event, please visit www.power-gennaturalgas.com TOTAL PAYMENT DUE - Please add all selections and total here: $ METHOD OF PAYMENT: Payment must be received prior to conference. ❍ Check enclosed (in U.S. funds only) (Please make payable to Pennwell/PGNG 2015) ❍ Wire transfer (Wiring information will be provided with invoice.) ❍ Credit Card: ❍ Amex ❍ Visa ❍ MasterCard ❍ Discover Payment must be received by published date to receive early registration discounts. Cancellations must be received in writing by July 18, 2015, for a refund, minus a $100 administrative charge. After July 18, 2015, refunds are not available. Substitutions may be made at any time, by contacting the registration department IN WRITING at [email protected]. Card Number:___________________________________________________ Expiration Date:_ ________________________________________________ Name on Card:_ _________________________________________________ Signature:______________________________________________________