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CASBAA India Forum 2012

20 March 2012 (Tuesday)
Shangri-La New Delhi

Registration Form
Please complete the following form in BLOCK LETTERS and fax to +852 2854 9530 or email to kenneth@casbaa.com .For
enquiries or registration by phone, please contact Kenneth Wong on +852 3929 1714.

Delegate 1 First Name: Last Name:
Job Title: Tel: Mobile:
Email: Fax:
Name to appear on the badge: Company to appear on the badge:

Delegate 2 First Name: Last Name:
Job Title: Tel: Mobile:
Email: Fax:
Name to appear on the badge: Company to appear on the badge:
Contact Person: Address 1
Company: Address 2
Tel: Address 3
Mobile: Postcode, Country:
Email: Industry:

 I wish to receive information on CASBAA Satellite Industry Forum 2012 to be held on Monday, 18 June.

Registration Fee
Fee includes refreshments, lunch, cocktail and documentation, but excludes accommodation and travel.
Regular Rate On-site Rate No. of persons Total amount
(ends 9 Mar)
 Member US$ 148 per person US$ 210 per person ___________ __________ GRAND TOTAL
 Non Member US$ 185 per person US$ 250 per person ___________ __________ __________

Payment Methods
Only credit card payment is accepted.

By Credit Card  VISA #  AMEX  MASTERCARD# FOR OFFICE USE ONLY
#Transaction by USD only
AUTH CODE DATE
Card No: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Cardholder Name: __________________________________________

Card Issuing Bank: __________________________________________

Date: _________________________ Total Amount: _______________________________________

Signature: ________________________ Expiry Date (mm/yy): _______________

Cancellation & Substitutions
There will be no refunds or cancellations. Substitutions must be sent on or before 9 March 2012 to kenneth@casbaa.com