DELEGATE FORM Delegate Registration Please register your participation at MINEX Kyrgyzstan 2018. Payment InformationSelect Payment Method* Credit Card (PayPal) Bank Transfer Delegate detailsNumber of delegates1 delegate2 delegates3 delegates4 delegates5 delegatesDelegate 1Name* Surname* Job Title Company* Email* Phone* Fax Mobile Delegate 1 Delegate = $250.00 Delegate - 15 min presentation = $500.00 Exhibitor (2 delegate passes, exhibition space, business presentation) = $1,000.00 Delegate 1 - Mine visit No visit Mine visit $100.00 Total $0.00 Exhibitor profileUpload company logo in EPS or JPEG formatAccepted file types: jpg, jpeg, png, gif.In EPS (vector) JPEG formatCompany profile in EnglishUp to 300 wordsCompany profile in RussianUp to 300 wordsDelegate 2Name* Surname* Job Title* Company Phone* Mobile Email* Delegate 2 Delegate = $250.00 Delegate - 15 min presentation = $500.00 Delegate 2 - Mine visit No visit Mine visit $100.00 Delegate 3Name* Surname* Job Title* Company Phone* Mobile Email* Delegate 3 Delegate = $250.00 Delegate - 15 min presentation = $500.00 Delegate 3 - Mine visit No visit Mine visit $100.00 Delegate 4Name* Surname* Job Title* Company Phone* Mobile Email* Delegate 4 Delegate = $250.00 Delegate - 15 min presentation = $500.00 Delegate 4 - Mine visit No visit Mine visit $100.00 Delegate 5Name* Surname* Job Title* Company Phone* Mobile Email* Delegate 5 Delegate = $250.00 Delegate - 15 min presentation = $500.00 Delegate 5 - Mine visit No visit Mine visit $100.00 Total $0.00 Delegate 6Name* Surname* Job Title* Company Phone* Mobile Email* Delegate 6 Delegate = $250.00 Delegate - 15 min presentation = $500.00 Delegate 6 - Mine visit No visit Mine visit $100.00 Total $0.00 Delegate 7 DetailsName* Surname* Job Title* Company Phone* Mobile Email* Delegate 7 Delegate = $250.00 Delegate - 15 min presentation = $500.00 Delegate 7 - Mine visit No visit Mine visit $100.00 Total $0.00 Delegate 8 DetailsName* Surname* Job Title* Company Phone* Mobile Email* Delegate 8 Delegate = $250.00 Delegate - 15 min presentation = $500.00 Delegate 8 - Mine visit No visit Mine visit $100.00 Delegate 9 DetailsName* Surname* Job Title* Company Phone* Mobile Email* Delegate 9 Delegate = $250.00 Delegate - 15 min presentation = $500.00 Delegate 9 - Mine visit No visit Mine visit $100.00 Total $0.00 Delegate 10 DetailsName* Surname* Job Title* Company Phone* Mobile Email* Delegate 10 Delegate = $250.00 Delegate - 15 min presentation = $500.00 Delegate 10 - Mine visit No visit Mine visit $100.00 Total $0.00 Your Comments* I have read and agreed to participation terms and conditions. Total $0.00 I want to receive newsletters and special offers from MINEX Forum events NameThis field is for validation purposes and should be left unchanged. Share with: 10th October 2018 Arthur Poliakov
