ࡱ> '` ybjbjLULU ;~.?.? 7RRRRRRRfn,n,n,8,2-fin:.P.^...///hhhhhhh$jhdmLiER1//11iRR..Hi4441R.R.h41h44V!=@RR=... 0k?n,2a= e$^i0im=xm 3*m=mR='/v/T4S0D0A///ii64X///i1111fffdffffffRRRRRR 24th Annual General Meeting Monday 19 to Thursday 22 September 2011 Radisson BLU Hotel, Nice France  Registration Form Please complete and return this form to ITIA by email to  HYPERLINK "mailto:info@itia.info" info@itia.info or fax to +44 20 8994 8728 before 19 August 2011, using a separate form for each company delegate. Registration fees must be paid by 19 August 2011. Name and contact details will only be included on the Attendance List after receipt of payment, at which time registration card will be issued. The registration fee covers attendance, coffee breaks, lunches, evening functions, and copies of the presentations (where available). First & Last NamesPositionCompanyAddressPhone NoFax NoEmail AddressOnly complete the following details if an invitation letter for a visa is neededFull Name on PassportNationalityPassport NoPassport Expiry Date For accompanying spouses, give details below and indicate attendance at functions by ("): Tue 20 Sept DinnerInterested in a spouse programme on Wed 21 Sept (see details on covering memo)Wed 21 Sept DinnerFirst & Last Names:Only complete the following details if an invitation letter for a visa is neededPassport No & Expiry DateNationality Registration Feesper DelegateAmountFee for first delegate from ITIA or Tungsten Consortium member companyUS$900Fee for other delegates from ITIA or Tungsten Consortium member companyUS$800Fee for each delegate from non-memberUS$1,300Speakers-Supplement for Registration after 19 August 2011US$200Spouse Fee (evening functions only). US$150TOTAL: See payment instructions and notes on Page 2 Notes: Payment Please arrange payment of registration fees by 19 August 2011 (see bank details below) with reference ITIA AGM, Name(s) of Delegate(s). Bank charges should be borne by payers. Invoices will be provided on demand. Cancellation Policy: Registration fees will be refunded to delegates whose written cancellations are received by the ITIA Secretariat by 19 August 2011, less an administration charge of 30%. There will be no refunds after that date, but substitutions will be accepted. Liability & Insurance It is a condition of booking that participants, members and representatives accept that neither the International Tungsten Industry Association, its employees, agents or ground operators, or the facilities to be visited, shall have any liability whatsoever for any personal injury sustained by, or damage to, accompanying guests or any consequential losses thereby. Please accordingly ensure that adequate insurance cover is taken to cover any such eventuality. I agree to the above conditions and will ensure that payment of the registration fee is made by bank transfer no later than 19 August 2011 to: Bank Name : NatWest Offshore Bank Address : Jersey, Channel Islands, UK Account Name : ITIA Symposium Account No : 9541-3035 5556 IBAN : GB93RBOS60954130355556 BIC / Swift : RBOSJESH Signature:Date:     Rue Pre E. 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