Event Secretariat. Graha Anugrah Building, 5th Floor. Jalan Teluk Betung No. 42.
Jakarta Pusat. Indonesia 10230. Phone +62 21 3913037. Fax +62 21 3913349.
Company Name Contact Name Title Address
CONTRACT CODE NO.
: : : :
PT Infrastructure Asia Event Secretariat Graha Anugrah Building, 5th Floor Jalan Teluk Betung No. 42 Jakarta Pusat Indonesia 10230 Phone +62 21 3913037 Fax +62 21 3913349
[email protected] www.indonesiainfrastructure.org
City : ZIP : Country : Email : Telephone : Fax : Line of Business : NPWP No.: (PLEASE NOTE : If invoice & NPWP address are different from above, please fill in the form on page 3)
DELEGATE DETAILS Delegate 1. Delegate 2. Delegate 3.
Name Direct Phone No. Business Email Name Direct Phone No. Business Email Name Direct Phone No. Business Email
: : : : : : : : :
Job Title : Mobile Phone : Job Title : Mobile Phone : Job Title : Mobile Phone :
JAKARTA CONVENTION CENTER, INDONESIA, 2013
Standard Rates
CONFERENCE FEE Delegates
US$ 1,100 Discount for Association Members of IABC
Discount 10%
Total number of delegates attending:
US$ 990 US$
Delegate passes for 2-days Conference includes 2 luncheons and 4 coffee breaks
* Please copy this form and repeat for additional delegate
VAT 10%
US$
TOTAL
US$
PAYMENT SCHEDULE & PROCEDURE
• 100% of total charges due with completed Forum Delegate Form • By bank transfer to: PT. Infrastructure Asia - Bank: CIMB Niaga, Branch: Warung Buncit
US$ - Acc. No. 212 . 02 . 00140 . 00 . 8 IDR - Acc. No. 212 . 01 . 00308 . 00 . 7
Swift Code: BNIAIDJA
Upon receipt of this contract the Organizer will issue an invoice. Upon receipt of the invoice from the Organizer payment is immediately due, to confirm your participation as conference delegate. This contract is only valid upon confirmed receipt of payment by the Organizer. Payment can be done by Bank Transfer, Cheque or Credit Card. For Cheque and Credit Card payments, please contact the Organizer for details. We hereby confirm our Conference participation at the IIICE’13 and we confirm our acceptance of the Rules & Regulations printed overleaf which form part of this contract. The execution of this contract and its receipt by ORGANIZER is deemed conclusive evidence of the Participant's agreement to pay the full fees due. THE CONTRACT IS NON-CANCELABLE BY THE DELEGATE. Delegate further acknowledges that the Organizer having incurred expenses as a result of the contract will not be required to refund any of the fees and that the Organizer is also entitled to any unpaid amounts that may be owing by the Delegate to the Organizer. I AGREE TO THE BOOKING CONDITIONS AND THE RULES AND REGULATIONS AND HEREBY CONFIRM THAT I AM AUTHORIZED TO SIGN THIS CONTRACT. Rp. 6,000 Duty Stamp
Authorized Signature: Name:
Organizer:
Date:
/
/
FORUM RULES AND REGULATIONS 1.
Participants shall be bound by the conditions, rules and regulations set forth in
sustained damages and losses as a result of the foregoing as well, and
this agreement and any changes must be made in writing and signed by
shall and does hereby waive any claims for damages or compensation.
an authorized official of PT. INFRASTRUCTURE ASIA (hereinafter referred to
The sums paid to ORGANIZER as fees or otherwise in connection with
as ORGANIZER) who shall have full power to interpret and to make or
the Conference shall remain the property of ORGANIZER.
amend these rules, provided that such amendments and additions do not
Participant is responsible to obtain adequate insurance to cover risk of
operate to diminish the rights reserved for the Participants under this Contract
this nature.
Form, and
The
shall not operate to increase liabilities of ORGANIZER, its 6.
Sponsors, Agents or Employees.
ORGANIZER is not responsible to assist the Participant in obtaining passport and visa for entrance into the country where the Conference is to
2.
be held. The fact that the Participant is unsuccessful in obtaining
No Participant shall be permitted to attend unless he has paid prior to the
these documents from the relevant authorities will not constitute a
Conference all of the fees agreed to on the reverse side.
basis for cancellation of this contract and it is clearly understood that no refunds whatsoever will be made. The Participant, however, may
3.
assign this contract to another party or company who meets the entry and
ORGANIZER, its Sponsors, Agents or Employees will not be obligated to put
government formalities necessary for entry into the country where the
up any advertisement when the advertising materials submitted by the
Conference is to be held. Such substitution shall be the sole responsibility
Advertiser or Participant are received after the deadline. While every care and
of the contracting Participant, and shall be notified in writing to
attention is exercised, ORGANIZER, its Sponsors, Agents or Employees and
ORGANIZER as early as possible before the start of the Conference.
the publisher of the Catalogue will not be responsible for any omission of an advertisement, or for any errors or omissions on any advertising copy submitted by the Advertiser or Participant. In the unlikely event of an omission
7.
oral or in writing-expressed or implied-have been made concerning
of an advertisement, the liability of ORGANIZER is limited to the refund of the
the amount of business to be gained from the Conference, its success, or
cost of the advertising space only. 4.
that ORGANIZER, or any of its subsidiaries or affiliates, employees or other entities allied with it has made any guarantees or assurances
The execution of the Conference Contract Form and its receipt by
concerning the Conference. The Participant further acknowledges that this
ORGANIZER is deemed conclusive evidence of the Participant's agreement to
document constitutes the entire agreement and the binding rules and
pay the full fees due. The Contract Form is non-cancelable, and the Participant
regulations existing between the parties, and that he has been given
further acknowledges that THE ORGANIZER, having incurred expenses as
no oral change or modification. No one is authorized to make any
a result of the contract, is not required to refund any of the fees agreed to on
oral changes in this agreement.
the reverse side, and that ORGANIZER is also entitled to any unpaid amounts that may be owed by the Participant to ORGANIZER. 5.
8.
Agreement is hereby submitted to the jurisdiction of the Court of Central
loss, damage or delay resulting from acts of war, civil unrest, strikes or in regulation, military
activity
or
any
The a g r e e m e n t s h a l l b e g o v e r n e d b y a n d c o n s t r u e d according t o Indonesian Law. Any dispute between the parties under this
ORGANIZER, its Sponsors, Agents or Employees shall not be liable for any lock-outs, change
The Participant expressly acknowledges that no representations-whether
Jakarta.
other
circumstances which shall make it impossible or inadvisable for ORGANIZER to hold the Conference at the time and place provided, and ORGANIZER
9.
The Participant agrees to the use of the Participant's company name,
reserves the right to reschedule the Conference at another date and/or at
company representative names, and company logo by ORGANIZER in
another site. Furthermore, ORGANIZER will not be responsible for, and will
promotional materials produced to market this event.
be
held harmless
from
the
consequences
of
any
conflicts
or
misinterpretations, which may arise with the host country, its agents or other bodies regarding any and all aspects of the Conference, which may affect the Participants. The Participant acknowledges that ORGANIZER will have
SECURE YOUR PARTICIPATION NOW!
INVOICE DETAILS INFORMATION Detailed information for invoice & NPWP Company Name : Invoice Address : NPWP Address : Finance Contact Person
:
Finance Direct Number :
BANK ACCOUNT INFORMATION OF PT INFRASTRUCTURE ASIA Account Name Bank US$ - Acc IDR - Acc Swift Code
: : : : :
PT. Infrastructure Asia CIMB Niaga - Warung Buncit No. 212 - 02 - 00140 - 00 - 8 No. 212 - 01 - 00308 - 00 - 7 BNIAIDJA
SECURE YOUR PARTICIPATION NOW!