MTF 2010

TABLE-TOP SELLER'S REGISTRATION FORM

Deadline : April 19, 2010

First Delegate
Full Name	:
Preferred Name on Badge	:
JobTitle	:
Company	:
Address	:
City	:	Country :
Phone	:	Fax :
Mobile Phone	:
Email	:
Feature of Business	:
Second Delegate
Full Name	:
Preferred Name on Badge	:
JobTitle	:
Note : A maximum of 3 (three) registered delegates on each table
Method of Payment	:	East Java Sellers
		Others
Table fee is inclusive of 2 (two) delegates
Intend to pay the registration fee by : (please tick)
		Bank Transfer (In full Amont) to :
		HARYONO TOUR & TRAVEL, PT
		Mice Division
		Jl. Sulawesi 27-29 Surabaya 60281
		Phone : (62-31)5049797, 503 3000, 503 4000
		Fax : (62-31) 504 3033
		Email : mice@haryonotours.com
		Account : Bank BCA Capem Kayun
		AC No. 788.082.1100 ( PT Haryono Dian Pertiwi )

Please read the important note below :
For payment by credit card, please sign and return this form to Haryono Tour and Travel
All bank administration/provision charge would be borne by the payer. No personal cheque is accepted
Please attach a. copy of remmitance of bank transfer or credit card in your registration form
A confirmation letter wold be issued and sent / taxed to each seller upon receiving full payment: