Registration Form


Personal Information * Required Field
Name:* (Given Name/First Name)	(Family/Surname/Last Name) *
Name on Badge:

Organisation:*

Address: *

City:

State/Province:

Postal/Zip Code:

Country: *

Telephone: *

Fax:

(include country and/or area code with telephone & fax)

Email:*

Registration Fees - Includes the cost of registration, tea breaks, conference material and meals

Check One:			Normal
Members			RM 1,280.00 (Approx USD 400)
Non-members			RM 1,440.00 (Approx USD 450)
1 Day Pass			RM 800.00 (Approx USD 250)

Please check this box for vegetarian meals arrangements.

*Click here for group registration form. (Group Rates are only applicable for FIVE (5) pax and above)

*If your company is registered as a sponsor, please check if you are entitled to the free entrance passes.
_______

CANCELLATION & REFUND
- If you are unable to attend, a substitute delegate is always welcome at no extra charge.
- Cancellation is possible only if the secretariat office receives written notification to that effect

PRIVACY DISCLOSURE
FTTH Council Asia-Pacific will not disclose any personal information to any third party without your consent except when it is necessary to fulfill your request or where FTTH Council Asia-Pacific is required to by applicable Law

Please mail or fax completed registration form with payment to:

Conceptual Events Asia Sdn. Bhd.
13-3, Jalan PJU 1/42A Block E2,
Dataran Prima 47301 Petaling Jaya
Selangor Darul Ehsan Malaysia.

Phone: (+603)7880-2502
FAX: (+603)7880-1154
Email: info@ftthasiaconference.org

Payment in Cheque (local) or Bank Telegraphic Transfer is to be paid to
CONCEPTUAL EVENTS ASIA SND BHD

Bank Detail

Bank:	PUBLIC BANK BERHAD
Address:	SS2 Branch, 61-1,61-2 & 61-3, SS2/75,
	47300 Petaling Jaya , Selangor, Malaysia.
Swift Code:	PBBEMYKL
Account No:	3146078301

Do not email credit card information because security cannot be guaranteed. You may fax or telephone credit card information.