IICCS Forum 2023 Registration

PERSON IN CHARGE DETAILS

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Salutation *

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Full Name *

Mobile Phone *

Job Title/ Position *

NIK/Passport *

Email Address *

Department *

COMPANY DETAILS

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Company Name *

Company Phone Number *

Facsimile *

Company Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

ACTIVITY PACKAGE

Select Package Type *

National
Overseas

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PAYMENT DETAILS

Invoice will be sent and payment should be made by bank transfer to:

IDR Account Number	: 067101000864306
Bank Name	: BANK BRI KCP BURSA EFEK INDONESIA
Beneficiary Name	: PT ENERGI KREATIF DINAMIKA

USD Account Number	: 495 314 9845
Bank Name	: BANK BCA BRANCH BURSA EFEK JAKARTA
Beneficiary Name	: PT ENERGI KREATIF DINAMIKA
Bank Swift Code	: CENAIDJA

FULL PAYMENT (100%) SHALL BE MADE PRIOR TO THE EVENT

TERMS & CONDITIONS

As Participant of The International and Indonesia CCS Forum 2023, we hereby agree to obey the following rules: *

I HAVE READ & ACCEPT THE TERMS & CONDITIONS, INCLUDING LIABILITIES, CANCELLATION, AND PAYMENT POLICIES, WITHOUT ANY RESTRICTIONS AND I CONFIRM THE ABOVE REGISTRATION.

• Convention Registration Form and Payment Receipt should be returned to secretariat@iiccsforum.com

• The Organizer will respond your email as our feedback. Form will be valid after signed by the person mentioned above.

• Any type of signed form sent via email has the same legal condition with the original document.

• Full payment (100%) shall be made before event.

• Cancellation requested by Participant shall be submitted the organizer in writing, completed with appropriate reason at least 30 days before event (11 August 2023) to receive 50% refund.

• The company regrets that HAVE MADE PAYMENT will get NO REFUND if cancellation notifications received by the organizer less than 15 days before event (3 September 2023).

• In case of force majeure, which includes natural disaster, flood, earthquakes, hurricanes, fires, epidemics, rebellion, wars, riots, civil unrest, explosions, act of terrorism, change in laws and regulations and/or economic policy/monetary/unstable political situation that directly affect the execution of this agreement, any subsequent delay of failure such shall not be regarded as the fault of the organizer shall be released from any liability due to impending result where the obligations pertaining the event cannot by duly met.

Please scroll down to read the T&C in full

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Participant Signature *

Any type of signed form sent via email has the same legal condition with the original document

Our Office

PLEASE COMPLETE THE REGISTRATION FORM

PERSON IN CHARGE DETAILS

COMPANY DETAILS

ACTIVITY PACKAGE

PAYMENT DETAILS

TERMS & CONDITIONS

Don’t forget:

OCT 7-8, 2025

Jakarta, INDONESIA