REGISTRATION FORM FOR CONFERENCE
Kindly fill up this registration form completing all the fields and send it along with your payment to: India Electronics &
Semiconductor Association:
Please use separate forms for each delegate from your company.
Delegate details
First name:
Job title/ designation:
E-mail:
Last name:
Mobile no:
Position (mark relevant)
Select your position by highlighting the necessary cell. Example Indian business leader
Indian business leader
PSU
International trade promotion agency
Global business leader
Indian technology leader
Venture capitalist / investor
Market analyst / researcher
Global technology leader
Any other (please specify)
Company details
Company Name:
Address:
City:
State/ province:
Telephone:
IESA Member:
Zip / postal code:
Country:
Facsimile:
Partner Association:
Company website:
Non Member:
Company type
Put tick (√) against company type. Example EDA company
Indian Aerospace & Defense
India head quartered semiconductor & service company
PSU
Multinational semiconductor/ services company
Internal Security
Semiconductor IP provider
Embedded semiconductor software company
TAPP service provider
Academic institution
Fabless company
Investor community / Venture capitalist
Companies with interest in & plans for India
Renewal energy companies
Others
Delegate fees in INR/USD
IESA members
Partner associations
Non members
Delegate fees in INREarly bird offer (on or
before Jul 31, 2015)
5000
6000
8000
Delegate fees in USD Early bird offer (on or
before Jul 31, 2015)
80
90
127
Kindly note: Delegate fees are inclusive of all taxes. Prior registration is necessary. Delegate fees are non-refundable. However, a
change in nomination is acceptable.
Payment details
Please find attached our Cheque / DD no ___________ for INR ____________drawn on______________ dated___________
in favor of “India Electronics & Semiconductor Association” payable at Bangalore, India
Note: Please carry a valid id proof for security purposes (passport/driving license/ PAN card) to be shown at the
Registration counter
For further details, please contact:
India Electronics & Semiconductor Association: Unit G-02, Ground Floor | Prestige Terminus-II | 901 Civil Aviation Road; (Old HAL
Airport Exit Road) | Konena Agrahara | Bangalore 560 017 | India. Phone: +91-80-4147-3250 | Fax: +91-80-4122-1866
Email: deftronics@iesaonline.org;
Online Registration: www.iesaonline.org