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REGIONAL WATER SAFETY PLAN CONFERENCE
Middle East and North Africa Region
Quality Assurance and Sustainable Drinking Water Services
10-12 OCTOBER 2011 – MUSCAT, OMAN
PLEASE COMPLETE THIS REGISTRATION FORM AND FAX / EMAIL TO +31 (0)70 34 77 005 / WSPMENA@IWAHQ.ORG
REGISTR ATION D ATA
(PLEASE WRITE IN CAPITAL LETTERS AND WRITE NAME, AS YOU WOULD LIKE THEM TO APPEAR ON NAME BADGE.)
TITLE:
FIRST NAME:
SURNAME:
ORGANISATION:
POSTAL ADDRESS:
CITY:
POST/ZIP CODE:
TELEPHONE:
STATE:
COUNTRY:
FAX:
E-MAIL:
MEMBER OF IWA YES NO
IF SO, PLEASE STATE MEMBER NO:
REGISTR ATION FEES
• PAYMENT MUST ACCOMPANY CONFERENCE REGISTRATION
• THE CONFERENCE FEE COVERS ATTENDANCE AT THE MAIN SESSION, MORNING AND AFTERNOON TEAS/COFFEES, LUNCHES, WELCOME
RECEPTION, GALA DINNER, PROGRAMME AND INFORMATION PACK
REGISTRATION FEE (PLEASE TICK CORRECT REGISTRATION RATE)
NON-IWA MEMBER (HIC*) 260 US DOLLARS (200 EURO)
IWA MEMBER (HIC*) 200 US DOLLARS (150 EURO)
IWA STUDENT MEMBER OR IWA LIC* MEMBER 130 US DOLLARS (100 EURO)
NON-IWA MEMBER STUDENT OR LIC* 165 US DOLLARS (125 EURO)
• HIC = HIGH INCOME COUNTRY; LIC = LOW INCOME COUNTRY. SEE WWW.IWAHQ.ORG FOR FULL LISTING OF HIC AND LIC
T ECHNIC AL VISI T
A TECHNICAL VISIT IS ORGANISED FOR OCTOBER 12 TH . THERE ARE TWO TECHNICAL VISITS ORGANISE:D 1. BARKA I DESALINATION PLANT (MSF), 2.
BARKA II (RO) DESALINATION PLANT. COST OF THE VISITS ARE INCLUDED IN THE REGISTRATION FEE. IF YOU ARE INTERESTED IN ATTENDING EITHER
OF THESE PLANTS PLEASE TICK BELOW:
BARKA I DESALINATION PLANT (MSF)
BARKA II (RO) DESALINATION PLANT
M ETHODS OF P AYMENT
ALL PAYMENTS IN EUROS (€) TO BE MADE BY CREDIT CARD, BANKERS DRAFT OR BANK TRANSFER (PERSONAL CHEQUES WILL NOT BE ACCEPTED)
AND MADE PAYABLE TO IWA.
BY CREDIT CARD BY BANK TRANSFER PAY ONSITE (CASH ONLY)
CREDIT CARD (VISA / MASTERCARD / AMEX / ACCESS):
CHARGE TO: VISA MASTERCARD AMEX ACCESS
CARD NO.:

CVV NO.:
BANK NAME ON CARD:
CARD HOLDER’S NAME:
CARD HOLDER’S ADDRESS:
CITY:
POST/ZIP CODE:
COUNTRY:
EXPIRY DATE:
BANK TRANSFER DETAILS:
PLEASE PROVIDE DETAILS OF TRANSFERS. CLEARLY MENTION YOUR NAME, DATE AND AMOUNT OF TRANSACTION, BANK OF ORIGIN AND QUOTE YOUR
SURNAME ALONG WITH WSP-MENA AS A REFERENCE. ALL PAYMENTS MUST BE FREE OF CHARGES TO THE RECEIVER (OUR).
ACCOUNT NAME:
INTERNATIONAL
WATER
ASSOCIATION
ACCOUNT NO.: 21527312
BANK: HSBC BANK ADDRESS: WESTMINSTER BRANCH
SWIFT CODE: 40-07-13 IBAN GB40MIDL40071321527312
P AYMENT ENCLOSE D
DELEGATE REGISTRATION FEE
TOTAL €
ALL REGISTRANTS ARE REQUIRED TO SIGN THE REGISTRATION FORM
OFFICE USE ONLY
SIGNATURE:
DATE RECEIVED:
DATE:
PROCESSED:
CANCELLATION POLICY: CANCELLATION OF REGISTRATION MUST BE CONFIRMED IN WRITING TO THE INSTITUTION RESPONSIBLE FOR MANAGING THE
REGISTRATION PROCESS. CANCELLATION RULES ARE THE FOWLLOWING:
CANCELLATION: REFUND VALUE :
PRIOR TO JULY 30 TH :
75 % OF FEES RECEIVED
FROM AUGSUT 1 ST TO
SEPTEMBER 1 ST :
AFTER SEPTEMBER 1 ST :
50 % OF FEES RECEIVED
NO REFUND
IMPORTANT: THE INTERNATIONAL WATER ASSOCIATION IS MANAGING THE REGISTRATION PROCESS FOR THIS CONFERENCE, PLEASE DIRECT ALL
CORRESPONDENCE TO WSPMENA@IWAHQ.ORG
COMPANY LIMITED BY GUARANTEE. REGISTERED IN ENGLAND NO. 3597005. REGISTERED OFFICE AS ABOVE. REGISTERED CHARITY (ENGLAND) NO. 1076690