CONFERENCE REGISTRATION FORM

General Information on NACE International East Asia & Pacific Rim Conference & Expo 2014
Event name : NACE International East Asia & Pacific Rim Conference & Expo 2014
Venue : Bali Nusa Dua Convention Center
Event Dates : September 2 4, 2014 : Conference and Exhibition
Registration : Please kindly return the form registration as soon as possible by Email
Print out this form and show the registration form on re-registration
Please kindly checking 2 hour or a half hour before
Participants will be recommended to arrive one day before the main
event
Gala Dinner Info : Gala dinner costs does not include the cost of registration


Mail completed form to: event@energynusantara.com

Participant Details:
NACE member number: Non-member Technical Paper Presenter **
*Last name (surname): Saputro
*First name: Novan Dwi
Nickname:
*Company name: Joint Operation Body Pertamina - Petrochina East Java
*Address: Jl. Lingkar Pertamina, desa Rahayu, Soko, Tuban

*City: Tuban *State/province: East Java
*ZIP/Postal code: 62372 Country: Indonesia
*Phone number: (0356) 811 911 Fax number: (0356) 811 955
*E-mail address: novan.saputro@jobppej.com

**Title of Technical Paper:

*Denotes a required field
**Required Field for Technical Paper Presenter
***Notes: If you a member of NACE, Please attach your ID member by scan or soft-copy.










Details of Your Company














MY COMPANY IS A(N): THICK
Academia/R&D
Asset Owner/Operator X
Association Government/Regulatory Agency
Manufacturer/Supplier
Media/PR/Advertising Agency
Service Provider/Contractor
No Company Affiliation
UTILITIES: THICK
Coal
Electric X
Gas Distribution X
Nuclear
Solar
Telecommunications
Water/Wastewater X
Wind
PRODUCTS I USE OR SELL THICK
(Select all that apply):
Abrasives X
Adhesives X
Application Equipment X
Coatings X
Concrete X
Data Recording and Management X
Equipment/Software X
Inspection Equipment X
Insulation X
Mechanical Equipment/Machinery X
Monitoring Equipment X
Safety Equipment X
Surface Preparation Equipment X
Testing Equipment X
Cathodic/Anodic Protection X
Chemical Inhibitors X
Linings MaterialsFerrous X
MaterialsNonferrous X
Maintenance/Rehabilitation X
Metal Fabrication X
Offshore X
PRODUCTS I USE OR SELL THICK
Agricultural Equipment
Chemical/Petrochemical X
Electronics X
Food Processing
Home Appliances
Mining
Oil and Gas Exploration/Production X
Pulp & Paper
Refinery/Gas Processing X
INFRASTRUCTURE: THICK
Airports
Gas and Liquid Pipelines X
Hazardous Material Storage
Highways/Bridges
Railroads
Waterways and Ports
Other Infrastructure
TRANSPORTATION: THICK
Aerospace/Aircraft
Automotive/Motor X
Marine/Ships
Vehicle
Hazardous Material Transport
Railroad Cars
Other Transportation
PRODUCTS I USE OR SELL THICK
(Select all that apply):
Onshore X
Original Equipment X
Rail Cars/Tank
Surface Preparation/Blasting X
Testing Services
Training X
Underground Storage X
Water Domestic X
Other/Company Function Not Listed
Materials Selection & Design X
Measuring, Analyzing & Controlling X
Instrumentation X
Manufacturer Power/Energy Distribution X
Power/Energy Generation X
Power/Energy Transmission X
Trucks Refining/Gas Processing X
Laboratory/Research X
Ship Building
Water Industrial
Wastewater Domestic
Wastewater Industrial X
Wind
GOVERNMENT: THICK
DoDMilitary
Nuclear Waste Storage
Other/Industry Segment X
Not Listed








CONFERENCE REGISTRATION PAYMENT
Please clearly and completely fill out all pages of this registration form. No telephone registrations are
accepted. Payment must be made in U.S. dollars or Indonesian Rupiahs, Registration will not be processed
without payment. Registration and payment date determine price and must be received by Energy Nusantara,
telephone registrations will be accepted.

Registration Fee
Registration Catagories Price Thick
NACE member conference registration USD 450

Non-NACE member conference registration USD 500

NACE member Student conference registration USD 250

Non-NACE member Student conference registration & Student Presenter USD 250

Technical Paper Presenter USD 400

Exhibition hall visitor Free

Function Tickets & Other Fees Amount Thick
Gala Dinner (Individual Ticket) USD 250

Official Hotel Package Amount Thick
Melia Bali Hotel (Deluxe Garden Room) 4 Night Package
Check in 1 Sept 2014 - Check Out 5 Sept 2014
USD 670

Melia Bali Hotel (Deluxe Pool Room) 4 Night Package
Check in 1 Sept 2014 - Check Out 5 Sept 2014
USD 850

BNDCC Hotel (Deluxe Room) 4 Night Package
Check in 1 Sept 2014 - Check Out 5 Sept 2014
USD 430

Total payment in US$

Note:
Conference Registration Fee Above does not include VAT (Value Added Tax), We will add the VAT tax in the invoice.
Hotel Package Price include VAT

Signature & Company Stamp




NACE INTERNATIONAL EAST ASIA & PACIFIC RIM AREA CONFERENCE & EXPO 2014 Secretariat will
send the invoice after receiving the completed registration form.

REGISTRATION & CANCELLATION POLICIES
All cancellations MUST BE SUBMITTED IN WRITING. If you cancel 35 DAYS PRIOR to the conference
you will receive a refund of 50%. If you cancel from 30 DAYS to 3 DAYS PRIOR to the conference you
will receive a refund of 10%. NO REFUNDS will be given 7 DAYS or less prior to the conference.


Mandiri Bank
Account Name: NACE IJS
USD: 156-000-776841-1
IDR: 156-000-776840-3
SWIFT CODE: BMRIIDJA
Email: event@energynusantara.com








HOTEL RESERVATION FORM
NACE International East Asia & Pacific Rim International Conference & Expo 2014
1 -5 September 2014

please complete the below form and return it to the Energy Nusantara, Email to,
event@energynusantara.com The following rates will be valid for all delegates of NACE International
East Asia & Pacific Rim International Conference & Expo 2014.

Name Company


Telephone Email

The Westin Resort Nusa Dua Hotel (*****)
Single Double/Twin Sharing with _________
Premium USD 180.00 Premium USD 180.00


Melia Bali Hotel (*****)
Single Double/Twin Sharing with _________
Premium USD 170.00 Premium USD 170.00


BNDCC Hotel (*****)
Single Double/Twin Sharing with _________
Deluxe USD 120.00 Deluxe USD 120.00


Courtyard Marriot Hotel (****)
Single Double/Twin Sharing with _________
Deluxe USD 135.00 Deluxe USD 135.00


Mercure Hotel (****)
Single Double/Twin Sharing with _________
Deluxe USD 75.00 Deluxe USD 75.00


Santika Siligita Nusa Dua Hotel (***)
Single Double/Twin Sharing with _________
Deluxe USD 70.00 Deluxe USD 70.00


Arrival Date Flight No Time


Departure Date Flight No Time

All prices include 21 % tax & service and breakfast for 2 persons.

Term & Condition :
Reservations must be guaranteed by cash or transfer to NACE IJS account.
Final review 30 days prior to arrival the released period , any room required will be subject to room availability
Any cancellation 14 days prior to arrival or no show a one night cancellation fee will be charged.
Any cancellation cause of force majeure e.g nature disaster, terrorist attack or political unrest allowed without penalty
Any late check-out require until 18;00 will be 50% from the rate offer and After 6:00pm one night room charge will be apply.
Payment must be settled in cash or by money transfers to the following account number.

Thank you and we look forward to welcoming you