Event registration form 2019 EFMD GN Asia Annual Conference "Vision 2030: Rising Asia — Impact Through the Power of Collaboration "Ho Chi Minh City, Vietnam, 07-08 November Date Date Format: MM slash DD slash YYYY Personal information:Name* Title Mr.Mrs.Ms.Dr.Prof. First Last Job Title*Company/Institution*Address* Street Address City ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Email* Phone*Purchase OrderMy portraitPlease attach your photo in JPG or PNG format (full face portrait; 5MB max.). The photo will be added to the participants list to facilitate networking.Accepted file types: jpg, jpeg, jpg, jpeg, png, png.Will you attend the EFMD Quality Services Seminar on 9 November?YesNoMembership:Membership Status*EFMD Full MemberEFMD Affiliated MemberNon-memberRegistration fee:"Early Bird" This fee is applicable until 2 September"Normal Fee" This fee is applicable between 2 September and 2 October"Late Fee"This fee is applicable after 1 October.as EFMD Full Member Price: 970,00 € as EFMD Affiliated Member Price: 1.070,00 € as Non-member Price: 1.170,00 € If you have a promotional code, enter it here: TOTAL 0,00 € These fees cover attendance to the meeting, documentation, meals and refreshments, but NOT hotel accommodations. Payment method*Bank transferCredit CardCredit Card Card Details Cardholder Name CANCELLATION POLICY: Cancellations must be confirmed in writing. If we receive notice of your withdrawal before 1 October 2019, a cancellation administrative fee of 75€ will be charged. Thereafter, we regret that we are unable to refund any fees. However, in such cases, substitutes are welcome at no extra cost as long as EFMD GN receives notification of the name, title and address of the substitute.Catering:I will join: Conference Dinner on 7 November Closing Dinner on 8 November I will also join: closing refreshments on 9 November I am allergic toalmondsblueberriesboletus mushroomchivesfigshazelnutsshellfishotherif 'other', please specify:*Dietary requirementsno dairy productsno fishno glutenno meatno nutsno porkno shellfishveganvegetarianotherif 'other', please specify:*General:I agree with the terms and general conditions stated on the EFMDGLOBAL website.* Yes I declare that all the information stated above is accurate, including allergies and dietary requirements.* Yes I authorise EFMD & EFMD GN to use all information communicated within the legal framework of its activities.* Yes I agree to receive an e-mail newsletter and other communication material from EFMD & EFMD GN.* I can unsubscribe or update my preferences at any time.YesNoTechnical InformationCommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.