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
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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
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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]
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