Questions? Contact:

Asia Pacific Office
Suite 23-02, Level 23 Centrepoint South
Mid Valley City, Lingkaran Syed Putra
59200 Kuala Lumpur Malaysia
Tel: +60.3.2288.1233
Fax: +60.3.2282.1220
Email: iptcreg@iptcnet.org

MEDIA REGISTRATION FORM

INTERNATIONAL PETROLEUM TECHNOLOGY CONFERENCE
Kuala Lumpur Convention Centre (KLCC)
3 – 5 December 2008, Kuala Lumpur, Malaysia

Participant Profile

All portions of this form must be completed.

Registrant's First Name/Forename:	(Name as you want it to appear on badge)
Registrant's Last/Family Name:
Email:
Job Title:
Organisation/Company:
Mailing Address:
City:
State/Province:
Zip/Postal Code:
Country:
Office Telephone:	(include country/area/city code)
Facsimile:	(include country/area/city code)

Questions? Contact:

MEDIA REGISTRATION FORM

Participant Profile

Please submit your MEDIA CREDENTIALS either by FAX: 60.3.2282.1220 or by EMAIL: iptcreg@iptcnet.org for our reference.

Please submit your MEDIA CREDENTIALS either by FAX: 60.3.2282.1220
or by EMAIL: iptcreg@iptcnet.org for our reference.