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2012 CDAMDAFDI World Dental Federation Joint International .pdf

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					   2012 CDA/MDA/FDI World Dental Federation Joint International Scientific Convention and Trade
                               Exhibition cum 69th MDA AGM
                            APPLICATION AND CONTRACT FORM
                             25-27 May 2012-Kuching, Malaysia
Please return this form to:                                      2012 CDA/MDA/FDI USE ONLY
International Centre for Industry Development                                 Date Rec’d________________
Level 1 Merdeka Palace                                                        Total Booth Cost____ _______
Jalan Tun Abang Haji Openg, 9300 Kuching                                      Deposit Received___________
Sarawak, Malaysia
                                                                              Booth No(s)_______________
Fax : +61 894 077 435                                                         _________________________
Contact : Jane
E-mail: cdamda2012@industrygrowth.net.
        Please type or print information in Block Letters
CONTACT ADDRESS
Company Name:_______________________________________________________________________
Address:______________________________________________________________________________________
_____________________________________________________________________________
Contact Person: (Mr/Mrs/Ms/Dr*)_________________________________________________________
Job Title:______________________________________________________________________________
Tel:___________________ Fax: ______________________ Email:_______________________________

INVOICING ADDRESS (IF DIFFERENT TO ABOVE)
Company Name:_______________________________________________________________________
Address:______________________________________________________________________________________
_____________________________________________________________________________
Contact Person: (Mr/Mrs/Ms/Dr*)_________________________________________________________
Job Title:______________________________________________________________________________
Tel:___________________ Fax: ______________________ Email:_______________________________

SIGNATURE & PAYMENT
Applications received without this information will not be considered.
We agree to abide by all provisions, rules and regulations as indicated in the 2012 Prospectus

Signature:___________________ Print Name:_______________________ Date: ______________

METHODS OF PAYMENT
 1 Visa/Mastercard                                                                 2   Directly into Bank
I wish to pay by Visa/MasterCard;please charge to my account                     Account Payee: CDA/MDA 2012
My card number is (16 digits)                                                    International Convention
                                                                                 Name of Bank: Public Bank Berhad
Signature ________________________Expire Date_______                             Branch: Jalan Tuanku Osman Sibu
Name (on card)____________________________________                               Branch
Address _________________________________________                                Account Number: PBB3165479111
________________________________________________                                 SWIFT Code: PBBEMYKL
Post Code:_____________ Country ___________________

                                                                                   3     By US Dollar Cheque/Bank
                                                                                         Draft Payable to:
                                                                                         “CDA/MDA 2012
                                                                                         International Convention”
                                                                                 Please fax copy of remittance to:
                                                                                 Malaysian Dental Association
EXHIBITION SPACE BOOKING
This if for:
                                       Booth Space including Standard Shell Scheme 3mx3m
                                       Booth Space including Island Shell Scheme 4mx10m
                                       Booth Space for our own stand (Raw Space)
                            th                                                                            th
Application received before 30 March 2012 must accompanied by 50% deposit(with the balance payable on 30 March 2012)
                             th
Application received after 30 March 2012 must accompanied by payment of the full balance in order to be considered.

Number of Booths                         RM               50% Deposit                                    _____________
                                                                              th
                                                          Balance (due on 30 March 2012)                 _____________
____x9sqm Standard Shell Scheme          ______           Preferred location, if available
____x40sqm Island Shell Scheme           ______
____ Raw Space                           ______           Preferably not next to or across from the following
                                                          company/companies:
Total:                                   ______


PROMOTIONAL & SPONSORSHIP OPPORTUNITIES

Please read 2012 CDA/MDA/FDI Prospectus for complete details on these opportunities.


                Advertising & other promotional activities will be invoiced separately

                                     Price(RM)           Quantity               TOTAL
 Scientific Programme
 Diamond Conference Partner          200,000
 Platinum Conference Partner         120,000
 Gold Sponsor                        70,000
 Silver Sponsor                      40,000
 Delegate Bag Sponsor
 Delegate USB Gift Sponsor           12,000
 Keynote Speaker Sponsor
 Lunch & Gala Dinner Sponsor
 Gala Dinner (Main Sponsor)          30,000
 Lunch Sponsor (Each Lunch)          15,000
 Advertising Rate
 Souvenir Programme
 Inner Front & Inner Back            3,000
 Centre Fold                         2,000
 Full Page Colour (A4)               1,500
 Exhibitors Directory
 Back Cover                          2,250
 Inner Front & Inner Back            1,500
 Book Mark                           1,500
 Full Page Colour (A4)               1,500

				
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