DELEGATE REGISTRATION FORM We request you to fill up all the ...
DELEGATE REGISTRATION FORM We request you to fill up all the ...
DELEGATE REGISTRATION FORM We request you to fill up all the ...
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<strong>DELEGATE</strong> <strong>REGISTRATION</strong> <strong>FORM</strong><strong>We</strong> <strong>request</strong> <strong>you</strong> <strong>to</strong> <strong>fill</strong> <strong>up</strong> <strong>all</strong> <strong>the</strong> fields. Complete this form and send with payment <strong>to</strong>:India Semiconduc<strong>to</strong>r AssociationUNI Building, 4th Floor, Millers Tank Bund Road, Bangalore 560 052, India.Please use separate forms for each delegate from <strong>you</strong>r company.Delegate detailsFirst name________________________________________________________________________Last name________________________________________________________________________Job title/ designation_______________________________________________________________E-mail___________________________________________________________________________Position (mark relevant)Select <strong>you</strong>r position by highlighting <strong>the</strong> necessary cell. Example Business leaderBusiness leaderMedia professionalHuman resource professionalTechnology leaderAcademic institutionCompany detailsMarket analyst / researcherVenture capitalist / inves<strong>to</strong>rGovernment officialAny o<strong>the</strong>r (please specify)Name___________________________________________________________________________Address__________________________________________________________________________City Zip / postal code_______________________________________________________________State/ province_____________________________Country________________________________Telephone_________________________________Facsimile________________________________Company website__________________________________________________________________Company typeISA Member______________________________ISA Non member___________________________Select <strong>you</strong>r company type by highlighting <strong>the</strong> necessary cell. Example EDA companyIndian semiconduc<strong>to</strong>r corporationIndia head quartered semiconduc<strong>to</strong>r &service companyPublic sec<strong>to</strong>r semiconduc<strong>to</strong>r companyMultinational semiconduc<strong>to</strong>r/ servicescompanyEDA companySemiconduc<strong>to</strong>r IP providerEmbedded semiconduc<strong>to</strong>r softwarecompanyTAPP service providerAcademic institutionCompanies with interest in & plans forIndiaInves<strong>to</strong>r community / VenturecapitalistMediaRenewal energy companies
Delegate feesISASEMIGovt. officialsEarly bird delegate fee till Oct 30 Delegate fee <strong>the</strong>reafter1 Day 3 Days 1 Day 3 Days4000 10000 5000 12000O<strong>the</strong>rs 6000 15000 7000 17000Figures in INR – inclusive of <strong>all</strong> taxesPayment detailsThrough Cheque/ DD_________________drawn in favour of “India Semiconduc<strong>to</strong>r Association”payable at Bangalore, India.Cheque/ DD number________________________________________________________________Drawn on________________________________________________________________________Dated for INR_____________________________________________________________________50% refund for cancellation before Oct 30, 2009. No refunds <strong>the</strong>reafter.Credit card/online payments – please visit www.isaonline.org
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