Conference Booking Form The following details are required for administrative purposes. You will be required to fill in registration details of each delegate you register on page 2. Company ("Client") Street: Town/City: Country:Please select... 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Sibiu Cuvasskaja Respublika Moskva Samarskaya oblast City of Kigali Al Madinah al Munawwarah Ar Riyad Ash Sharqiyah Asir Makkah al Mukarramah Dakar Central Singapore Eastern Cape Free State Gauteng Kwazulu-Natal Limpopo Mpumalanga Western Cape Chungbuk Chungnam Daejeon Gyeonggi Gyeongnam Incheon Jeonbuk Seoul Albacete Asturias Barcelona Castello Catalunya Cordoba Galicia Gipuzkoa Granada Jaen La Rioja Madrid Malaga Pontevedra Sevilla Toledo Valencia Valenciana Zaragoza Colombo Stockholms lan Aargau Geneve Luzern Vaud Zug Zurich Changhua Hsinchu Kaohsiung New Taipei Taichung Tainan Taipei Taoyuan Bangkok Chiang Mai Chon Buri Lampang Nonthaburi Rayong Samut Prakan Port of Spain Tunis Adana Afyonkarahisar Ankara Antalya Bursa Denizli Gaziantep Istanbul Izmir Kayseri Kocaeli Konya Manisa Samsun Yalova Kampala Kyiv Abu Dhabi Ajman Dubai Fujairah Ras Al Khaimah Sharjah Umm Al Quwain Aberdeen City Aberdeenshire Angus Ards and North Down Belfast Birmingham Bristol Buckinghamshire Cambridgeshire Central Bedfordshire Cheshire East Cheshire West and Chester Conwy Cornwall Coventry Cumbria Derbyshire Devon Dorset Durham County East Riding of Yorkshire East Sussex Edinburgh Essex Fermanagh and Omagh Flintshire Gloucestershire Hampshire Hertfordshire Hounslow Isle of Wight Kent Lancashire Leeds Leicestershire Lincolnshire London Manchester Midlothian Milton Keynes Monmouthshire Norfolk North Yorkshire Northamptonshire Northumberland Nottinghamshire Oxfordshire Pembrokeshire Powys Renfrewshire Scotland Shropshire Somerset Staffordshire Suffolk Surrey Vale of Glamorgan Warwickshire West Berkshire West Lothian West Sussex Wiltshire Worcestershire York Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Anzoategui Distrito Capital Zulia Binh Duong Long An Sai Gon Salutation:Please select... Dr. Eng. HE HH Miss. Mr. Mrs. Ms. Sheikh Sheikha First Name: Last Name: Job Title: Email: Telephone: VAT Registered Yes No VAT No Which best describes the industry your company operates in?Please select... Academia & Research Institutions Alternative & Renewable Energy Architecture & Building Consultancy Embassy End User Energy Intensive Users Energy Producer Energy Storage Technology Engineering, Procurement, Construction & Management Exploration & Production Financing, Contracting, Pricing & Trading Government Health, Safety, Security & Environment Human Resources Hydrocarbons Refining Industry Associations Marine, Shipping & Storage Media Mining Miscellaneous Services Providers Natural Gas Vehicles Non-Government Organisation Power Generation Technology Sustainability Solutions Terminals, Storage & Bunkering Transmission, Distribution & Power Generation Transmission & Distribution Technologies Select Number of Delegate Places (up to 5 bookings online) Rate Quantity Total ALL ACCESS CONFERENCE USD Please select... 1 2 3 4 5 USD STRATEGIC CONFERENCE USD Please select... 1 2 3 4 5 USD TECHNICAL CONFERENCE USD Please select... 1 2 3 4 5 USD EQUALITY IN ENERGY USDCONFERENCE & AWARDS CEREMONY Please select... 1 2 3 4 5 USD HSE IN ENERGY CONFERENCE USD& AWARDS CEREMONY Please select... 1 2 3 4 5 USD FINANCE AND INVESTMENT USD SUMMIT & AWARDS CEREMONY Please select... 1 2 3 4 5 USD Finance & Investment USD Brunch Please select... 1 2 3 4 5 USD Security in Energy USD Please select... 1 2 3 4 5 USD Total Quantity Subtotal USD including 14% Tax Total Price USD If you have 6 or more delegates to register then please email us at egyps.delegate@dmgevents.com Page 2 DELEGATE REGISTRATION DETAILS Please enter the details of the delegate that you wish to register Salutation:Please select... Dr. Eng. HE HH Miss. Mr. Mrs. Ms. Sheikh Sheikha First Name: Last Name: Email: Telephone: Job Title: What products and services are you looking for at the show?(To select multiple options please press the CTRL button and select the values from the list)Please select... Certification & Classification Compressors Construction Corrosion & Abrasion Control Drilling Electrical Equipment Engineering Environmental Equipment Exploration Gas Compressor Gas Distribution & Power Generation Gas Exploration & Production Gas Treatment Gasification Government / Regulatory Health & Safety Instrumentation IT & Telecommunication Maintenance & Repair Marine Media / Publications Natural Gas Offshore-Drilling Offshore-Equipment Offshore-IT Offshore-Maintenance Offshore-Pumps Offshore-Rigs Offshore-Services Offshore-Vessels Oil and Gas Storage & Transportation Other (Please specify) Pipelines Pipes Portable Heaters Power Systems Process Plants Processing Production Pumps Security Ships, Boats, Vessels Storage Technical Services Tools Transportation Valves Well Completions Others What is your nature of business?Please select... Agent, Distributor, Supplier Consultancy Downstream Education & Training EPC/FEED Exploration & Production Gas Production Government Health & Safety Investment IOC Maintenance & Repair Manufacturer Midstream NOC Oil & Lubricants Other (Please specify) Part Supplier Petrochemicals and Refining Pipeline Services Plants & Terminals Processing & Production Research & Development Safety & Security Services Service Trade Association Transport & Handling Others What is your level of seniority?Please select... Architect Assistant C - Level Chairman/Board Member Diplomat Director/VP Engineering Executive Head/Senior Manager Manager Minister Other (Please specify) Others What is your purchasing responsibility?Please select... Influencer Purchaser / Buyer Decision Maker End User None What budget range are you responsible for?Please select... Up to $500,000 Up to $1,000,000 Up to $5,000,000 Up to $10,000,000 Up to $25 million Up to $50 million Up to $100 million $100 million + Don't know None Other (Please specify) Others What is your job function?Please select... Engineering - Civil Engineering - Electrical Engineering - Geotechnical Engineering - Mechanical Engineering - Other (Construction) Engineering - Other (Oil & Gas) Engineering - Structural Finance General Management Government Human Resources Information Technology Information Management International Management Investment Management Legal, Taxation & Auditing Marketing Operations & Logistics PR, Media, Ads & Comms Purchasing Research, Analysis & Strategy Sales & Marketing Sales/Business Development Specifier Unclassified Other (Please specify) Others What is your department?Please select... Auditing Drilling & Completions Field Development Gas Gas Technology Geo Science Health & Safety Integrity Learning & Development Maintenance Procurement Projects Unconventional Are you attending with a view to exhibit in the future?Please select... Yes (Note: There is a cost to exhibit at the event) No PAYMENT OPTION Invoice / Bank Transfer (Invoice and bank details will follow)Credit/Debit Card (Invoice will be emailed on completion of payment) By clicking the “Submit” button after your payment selection has been made, you are agreeing to the booking terms & conditions.Having read and agreed the terms of this contract (including the Terms and Conditions), we the Client hereby purchase the Products indicated in section "Delegate products" and shall pay the fees indicated in accordance with the payment Terms and Conditions. By submitting this Booking Contract, I acknowledge that I have read and agree on behalf of the Client the terms of this contract, including for the avoidance of doubt, the Terms and Conditions. Please email egyps.delegate@dmgevents.com for issues / queries with your booking. PRIVACY NOTICE By ticking this box, you confirm that you agree to sharing your information with this event’s sponsors and partners. By ticking this box, you confirm that you agree to our T&Cs and our Privacy Notice. You have the right to withdraw consent to marketing at any time by emailing privacy@dmgevents.com OR by following the opt-out links on any marketing message sent to you. By submitting the registration form you agree to our Registration terms & conditions.