Registration Form with Payment

Registration
Company*
Company E-mail*
Company WebSite*
Mobile Number*

Country CodePrefixPhone Number
Full Name*

PrefixNameMiddle NameSurnameSuffix
Role / Position*
Department*
Department Sector

AutomationElectricalMechanicalICTAdminOther
Desk Phone Number*

Country CodePrefixPhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Followed Areas

Type option 1Type option 2Type option 3Type option 4
Followed Areas
Number of people attending*
Payments are processed through PayPal. You may pay using an existing PayPal account, or any major credit card / debit card.

Event

3 Days Conference Full-Access$ Free

Quantity
Item subtotal:$0.00

Day 1 - Level 2 / PCS - Conference WorkShop$150.00

Quantity
Item subtotal:$0.00

Day 2 - Level 3 / MES - Conference WorkShop $ Free

Quantity
Item subtotal:$0.00

Day 3 - Business Intelligence & Smart Plants$ Free

Quantity
Item subtotal:$0.00

Total $0.00

Payment Method
Credit	Express