IAOM - Middle East & Africa District

Accepted Cards

CONFERENCE REGISTRATION FORM

Title*

Last Name*

First Name*

Company*

Please indicate the business field your company relates to:*

	Milling
	Trading
	Manufacturing
	Supplier
	Other

Job Title*

Address*

City*

State/Province

Zip/Postal Code*

Country*

Telephone No.*

Fax

Email*

Mobile

Website

Check all that applies*

	Member
	Non-Member
	Exhibitor
	First Time Conference
	Speaker

Membership Information -

Membership Type

IAOM Membership No.

Expiry Date

(dd/mm/yyyy)

Spouse Information -

Spouse Full Name

Child Full Name

(age 12 and under)

1.
2.
3.

Conference T-Shirt -

Complimentary only for Conference delegates including exhibitors. Not applicable for spouse.
Please indicate your T-Shirt size requirements. We will try our best to accommodate your request.

Select Size*

Banquet Preferences -

Please indicate your choice which will be considered for set menus served during the conference.

Select Preference*

Applicable Fees* :

Conference Registration	Before 30/09/10	After 30/09/10	Total Cost
IAOM Member	$400	$450	$
Non Member	$550	$600	$
The difference of $150 in the conference registration fee for non members is considered as a payment of a full one year IAOM membership valid from 1st of January 2011. Annual standard membership fee is $195.
Other
Spouse	$400	$450	$
Exhibitors (2 persons only)	Free of charge
			$

I confirm that I have read and agree to the Terms and Conditions of Conference Registration as specified here.