CONFERENCE REGISTRATION FORM 2010 SPE/IADC Managed Pressure Drilling & Underbalanced Operations Conference & Exhibition 24-25 February 2010, Shangri-La Hotel, Kuala Lumpur, Malaysia Online registration is available at: http://www.iadc.org/conferences/MPD_UBO Please complete the entire form. Duplicate this form for additional registrants. Mr./Ms. First (Forename) Name Mid. Init. Last (Family) Name Name to be printed on your badge Job Title Company Office Address / PO Box City State Zip/Postal Code Country E-Mail Address (IMPORTANT: Please complete so IADC can forward the conference proceedings) Office Telephone Office Fax Fee Information Cancellations are subject to a US $ 25 processing fee. No refunds for cancellations after 23 January 2010. Registration Fee: US $ 850,- Payment Information Cheques, money orders, wire transfers, or credit cards are acceptable. Payment must be made prior to the conference. All credit card payments will be charged in US Dollars. * A processing fee of US $ 25 must be included for all wire transfer payments. Payment Enclosed American Express MasterCard Visa Wire Transfer* *Complete Form on Back Credit Card Number: Expiry Date: Cardholder Name: Signature: Credit card registrations: Fax to IADC at +31/24-3600759 (Netherlands) or +1/713-292-1946 (US) Checks: Mail checks to IADC, PO Box 1430, 6501 BK, Nijmegen, The Netherlands Door registrations: Payments may be made at the door in US Dollar $ 850 For more information, call IADC The Netherlands - Anne Otten at +31/24-6752252. US – Leesa Teel at +1/713-292-1945 IADC USE ONLY – MP0 CID NO. PID NO. WIRE TRANSFER FORM 2010 SPE/IADC Managed Pressure Drilling & Underbalanced Operations Conference & Exhibition 24-25 February 2010, Shangri-La Hotel, Kuala Lumpur, Malaysia Please include a US $ 25 processing fee for all wire transfer payments. Date: Name: Company Name: Bank Issuing: Amount: Confirmation Number: Wire Transfer Information: IADC, the Netherlands Rabobank Nijmegen, PO Box 144, 6500 AC Nijmegen, the Netherlands Acct. Name: In-Act, inzake I.A.D.C. Netherlands Acct. No. 1358.53.206 Bankcode 1378 Swiftcode: RABONL2U Ibannumber: NL38RABO0135853206 VAT: 165080899B01 Fax to IADC, 31/24-3600759 (Netherlands) or 1/713-292-1946 (US) For additional registrations, please duplicate this form. Please assist us in tracking your payment by including the conference registrant’s name and referencing “MP0” on your bank draft form. If you have a special physical or communication need that may impact your participation in any of these activities, please contact Anne Otten at phone:+31/24-6752252/ fax:+31/24- 3600759 or Leesa Teel at phone:+1/713-292-1945 ext 210/fax:+1/713-292-1946.
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