CONFERENCE REGISTRATION FORM Please forward your completed form to LET2015 secretariat at [email protected] by 25 MAY 2015. Submit one form per delegate. Please visit www.let2015.org for more information on the conference. SECTION A – DELEGATE INFORMATION Family Name: Prof Dr Mr Ms Mrs (please tick) Given Name: Organisation: Job Title: Mailing Address: Post/ Zip Code: Country: Tel No: Fax No: Email: Special Dietary Requirement* (if applicable): *All meals have no pork/ no lard Vegetarian/ Others (Please specify): SECTION B – PROFESSIONAL PARTICULARS Type of organisation (Tick ONE only) Consultant / contractor NGO Others, please specify: Educational institution Regulator Government Research / Analytical lab International Organisations Utility Manufacturer / Supplier United Nations Policy Researcher Scientist Primary work role (Tick ONE only) Engineer / Technical Manager Student Others, please specify: SECTION C – VISA I require a visa to enter Hong Kong. Please send me a letter to support my visa application. I understand that I will only receive a letter when the organisers have received my payment in full. SECTION D – REGISTRATION NOTE - All registration fees include attendance at the sessions, entry to the posters' gallery, lunch, morning and afternoon teas, welcome reception and the conference gala dinner. Are you a Member of IWA? * Yes No Is your organisation a corporate member of IWA? * Yes No *If yes, please quote IWA membership number Membership of IWA will be verified. Membership status is not transferable. If the member number supplied is incorrect no discount will apply. For Non-IWA Members, would you like to apply for an IWA individual membership to enjoy the member rates for the Conference? Yes If yes, please tick the membership category below that you wish to apply. An IWA staff will be contacting you once the fee is received. IWA MEMBERSHIP CATEGORIES 1-Year Membership (2015) High Income Country – Standard Individual Member 2-Year Membership (2015 – 2016) € 101 € 50 € 51 € 36 High Income Country – Retired / *Student Member Low Income Country - Individual Member Low Income Country – Retired / *Student Member No € 182 € 90 € 92 € 65 *In order to be eligible for Student membership you need to provide your Head of Department name, Head of Department email address and Graduation year. LET2015 REGISTRATION FEES EARLY BIRD NORMAL ON-SITE payment received by 15 April 2015 payment received by 25 May 2015 Applicable after 25 May 2015 High-Income Country IWA Member € 650 € 750 € 850 Low-Income Country IWA Member/ Student Member € 430 € 780 € 480 € 500 € 880 € 550 € 550 Please select by ticking the applicable fees for your registration High-Income Country Non-IWA Member Low-Income Country Non-IWA Member/ Student Non-Member € 1000 € 600 For a complete list of low-income countries, please visit our website www.let2015.org P a g e |1 CONFERENCE REGISTRATION FORM SECTION E – WORKSHOP ON 31 MAY 2015 Yes, I will attend the workshop on 31 May 2015 (Sun) Workshop 1: Innovations to create and scale up a sanitation industry Workshop 2: Water Sensitive Cities: designing and planning for water resilient societies with diversified water supply Workshop 3: Food Waste: From Waste to Resource No, I will not join the workshop. SECTION F – TECHNICAL TOUR ON 30 MAY 2015 Yes, I will join the technical tour on 30 May 2015 (Sat) at €20 per person Tour 1: The sludge treatment facility Tour 2: Seawater pumping station & SANI demonstration plant No, I will not join the technical tour. SECTION G – SOCIAL FUNCTIONS Yes, I will attend the welcome reception by myself Yes, I will attend the welcome reception with my partner Welcome reception on 31 May (Sunday) (please indicate extra number of tickets required: _____________) Extra tickets are priced at €25 each No, I will not attend the welcome reception Yes, I will attend the conference gala dinner by myself Yes, I will attend the conference gala dinner with my partner Conference gala dinner on 3 June (Wednesday) (please indicate extra number of tickets required: _____________) Extra tickets are priced at €100 each No, I will not attend the conference gala dinner SECTION H – PRIVACY SECTION I – SUMMARY OF FEES As a result of your participation in this event, the details you have provided will be on the IWA database. We respect your privacy and will remove your details from the database if you ask us to. After the event we would like to send you information on future related conferences, seminars and exhibitions. If you do not wish to receive this information please tick here. Section D: IWA Membership Fee (if applicable) € Section D: LET2015 Registration Fee € Section F: Technical Tour on 30 May 2015 € Section G: Additional Social Function Tickets € TOTAL AMOUNT: € 0 SECTION J – PAYMENT Please select your method of payment by putting a tick in the box below BANK TRANSFER in Euros (€) to the following account. Kindly quote “LET2015” followed by the delegate’s name when making the bank transfer. Account name: Account number: Swift code : Bank: IBAN: International Water Association 57369004 MIDLGB22 HSBC Plc GB15MIDL40051557369004 CREDIT CARD (Please provide details below) Type of Card Credit Card Number Cardholder’s Name Visa MasterCard AMEX Expiry Date: (MM/YY) CCV: AMEX –4 digit code found on the front of the card Visa, MasterCard—3 digit code found on the back of card Cardholders Signature P a g e |2 CONFERENCE REGISTRATION FORM SECTION K – CANCELLATION POLICY Cancellations must be notified in writing to the conference organizers. Telephone cancellations will not be accepted. Cancellations received prior to 1 May 2015 will receive a full refund less a €50 administration charge. Refunds will not be issued for cancellations received after 1 May 2015. Substitute delegates will be accepted without charge. SECTION L – CONDITIONS 1. 2. 3. 4. 5. 6. 7. 8. Applications for registration must be in writing. Telephone registration will not be accepted. All prices quoted in this form are in Euros (€). Payment must be made in Euros. Any bank transfer fees and charges are the responsibility of the delegate. Registration cannot be confirmed until payment has been received. Credit card payments will appear on your credit card statement with "International Water Association" as the merchant. International Water Association (IWA) membership is not transferable. If you are unable to attend you may nominate another person as a substitute. You must do this in writing to the conference organizers at [email protected]. There is no refund for non attendance except as outlined in the cancellation policy. Children must be accompanied by a parent or guardian at all times. The parent or guardian assumes all risks and responsibility for the safety of their children. Parents please note the social functions have not been planned with children in mind. 9. The conference organizers have made every effort to ensure the accuracy of details in this form at the time of printing but reserve the right to alter or delete items from the programme or services as circumstances require. 10. The conference organizers are not liable for any claims, damage or expense arising out of cancellation, disruption, changes or limitations to the programme or services as a result of any circumstances outside their control including weather, terrorist event, travel restrictions, visa refusals or biological or health hazard or event. 11. Delegates are advised to arrange their own travel insurance to cover medical expenses, cancellation and all other risks. The conference organizers, their officers and employees are not liable for and the delegate releases them from any liability for claims, damage or expense whether in respect of personal injury, death, loss or damage to the delegate or partner(s). 12. Instructions and other provisions in the registration form, including the cancellation policy, are part of these registration conditions. SECTION M – ACKNOWLEDGEMENT Please process my registration as completed on pages 1 and 2. I have read and agree to the conditions and cancellation policies as indicated on page 3. ____________________________________________________________ Name & Signature ________________________ Date (DD/MM/YYYY) Please forward your completed registration form to [email protected] P a g e |3
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