Please return the form to:Organizing Committee WGC2010
Grha Bimasena
Jl. Dharmawangsa Raya 39
Jakarta Selatan, Indonesia
Phone : +62-21 7258668
Fax: +62-21 7236193
E-mail : secr@wgc2010.org
Website : www.wgc2010.org

WGC2010World Geothermal Congress
25 – 30 April 2010
Bali International Convention Centre, Nusa Dua
Bali - Indonesia

CONGRESS REGISTRATION FORM
REGISTRATION NUMBER (Official use only)

PERSONAL INFORMATION (Please use BLOCK LETTERS)
Mrs.

Mr.
First Name

Ms.

:

Last Name:City:

Title (e.g. Prof., Eng., Dr., etc) :Company/Institution:

Position:

Address:

Post Code:State/Country :Telephone:

Fax:

Mobile Phone:

E-mail:Paper submitted

Yes

No

If yes, paper number :Fellowship submitted

Yes

No

If yes, please fill in the Fellowship Application Form

ACCOMPANYING PERSON(S)
Mr.

Mrs.

Ms. First Name :Last Name

Mr.

Mrs.

Ms. First Name :Last NameREGISTRATION FEES (USD)EARLYNORMALLATE - ONSITE(Before 30 November 2009)(1 Dec - 28 Feb 2010)(1 March 2010 - onwards)

IGA Member

550650700

Non-IGA Member

650750800

Cat A*

425500550

Cat B**275

325350Non Category

200250300

Cat A*150200225

Cat B**100125150

DELEGATESACCOMPANYING PERSON*Cat. A: Upper-middle-income economies whose participants may obtain reduction in Registration fees: American Samoa, Argentina, Belize,
Botswana, Brazil, Chile, Costa Rica, Croatia, Dominica, Equatorial Guinea, Gabon, Grenada, Hungary, Kazakhstan, Latvia, Lebanon, Libya,Lithuania, Malaysia, Mauritius, Mexico, Mariana Islands, Oman, Palau, Panama, Poland, Romania, Russian Federation, Serbia and Montenegro,Seychelles, Slovak Republic, South Africa, St. Kilts and Nevis, St. Lucia, St. Vincent and the Grenadines, Turkey, Uruguay, Venezuela.
**Cat. B: Low- & Lower-middle-income economies whose participants may obtain reduction in Registration fees: Afghanistan, Albania, Algeria,Angola, Armenia, Azerbaijan, Bangladesh, Belarus, Benin, Bhutan, Bolivia, Bosnia and Herzegovina, Bulgaria, Burkina Faso, Burundi, Cambodia,Cameroon, Cape Verde, Central African Republic, Chad, China, Colombia, Comoros, Congo (Dem. Rep.), Congo, Cote d'lvoire, Cuba, Djibouti,Dominican Republic, Ecuador, Egypt, El Salvador, Eritrea, Ethiopia, Fiji, Gambia, Georgia, Ghana, Guatemala, Guinea, Guinea-Bissau, Guyana,Haiti, Honduras, India, Indonesia, Iran, Iraq, Jamaica, Jordan, Kenya, Kiribati, Korea (Dem. Rep.), Kyrgyz Republic, Lao PDR, Lesotho, Liberia,Macedonia FYR, Madagascar, Malawi, Maldives, Mali, Marshall Islands, Mauritania, Micronesia, Moldova, Mongolia, Morocco, Mozambique,Myanmar, Namibia, Nepal, Nicaragua, Niger, Nigeria, Pakistan, Papua New Guinea, Paraguay, Peru, Philippines, Rwanda, Samoa, Sao Tome andPrincipe, Senegal, Sierra Leone, Solomon Islands, Somalia, Sri Lanka, Sudan, Suriname, Swaziland, Syria, Tajikistan, Tanzania, Thailand, TimorLeste, Togo, Tonga, Tunisia, Turkmenistan, Uganda, Ukraine, Uzbekistan, Vanuatu, Vietnam, WestBankandGaza, Yemen, Zambia, Zimbabwe.

(Categories based on income list of World Bank - March 2008)

PAYMENT
I intend to pay by bank telegraphic transfer to :Pacto WGC 2010
Lippo Bank - Kuningan Lippo Life, Plaza Centris Lt. 1Jl HR Rasuna Said Kav B-5, Kuningan, Jakarta 12910
Phone : 62-21-2524860 Fax : 62-21-2525070 / 71
A/C (USD) : 705 - 30 - 70810 - 4
A/C (IDR) : 705 - 30 - 09344 - 4
I intend to pay by credit card and here with authorize PACTO CONVEX Ltd. to charge the above amount by:
VisaMasterCard
Card number:

Expiry date:

Card holder name :Card holder Signature :Note :

Security number :(month/year)

Address:

Total Amount:

Date:

Should you pay by telegraphic transfer, the Conference Organizer must receive the FULL AMOUNT. For our reference and administration purposes, please
copy us the bank transaction and sent it by fax to (62-21) 7236193 and (62-21) 5705798 or email to secr@wgc2010.org
Payment by credit card is normally charged in local currency. The committee takes no responsibility for subsequent exchange rates applied by credit card
vendors when your statement is converted into local currency

I hereby authorize the Indonesian Geothermal Association to debit the above mentioned credit account with the total value of the items booked by meon this form.
I have read and agreed to the Disclaimer of Liability posted on the Congress website and agree to abide by decisions of the Organizers or persons
entrusted by the Organizers, with respect to operation of the Congress.

Signature :Date :CANCELLATION
If, after registering to attend WGC2010 and its associated activities you have to cancel your registration for any reason then it must be done in writing
to the Organizers, who must receive this notice before 28 February 2010. Refunds, less a US$ 100 administration charge, will be issued after theCongress. No refunds will be issued for cancellations received after 28 February 2010. Participants who register but do not attend the Congress, orattend only a part of the Congress, will be responsible for the full registration fee. Refunds of cancelled registration fees cannot be applied to future
World Geothermal Congress events.
Participants agree to abide by decisions of the Organizers, or individual persons entrusted by the Organizers, with respect to operation of theCongress.

PLEASE DO NOT FORGET TO TAKE A COPY FOR YOUR OWN RECORDS!

Please return the form to:Organizing Committee WGC2010
Grha Bimasena
Jl. Dharmawangsa Raya 39
Jakarta Selatan, Indonesia
Phone : +62-21 7258668
Fax: +62-21 7236193
E-mail : hotel@wgc2010.org
Website : www.wgc2010.org

WGC2010World Geothermal Congress
25 – 30 April 2010
Bali International Convention Centre, Nusa Dua
Bali - Indonesia

HOTEL - FIELD TRIPS - DAY TOURSREGISTRATION FORM
REGISTRATION NUMBER (Official use only)

PERSONAL INFORMATION (Please use BLOCK LETTERS)
Mr.

Mrs.

First Name:

Sharing with:

Company/Institution:

Address:

Ms.
Last Name:City:

Post Code:State/Country :Telephone:Fax:

Mobile Phone:

E-mail:Please make your choice from the accommodation page
1st Choice :Hotel check in date// 2010

2nd Choice :Hotel check out date// 2010

3rd Choice :Number of Rooms

Number of Nights

Daily Tariff (Deposit Amount)Single Room
Double Room

Subtotal USD
Exclusive of 21% VAT

Estimated arrival time

Estimated departure time

HOTEL RESERVATION AND CANCELLATION CONDITIONS
Hotel reservation will be confirmed when the Congress Secretariat has received your registration form together with your hotel deposit (USD
250 for 5 stars, USD 200 for 4 stars and USD 150 for 3 stars / exclusive of 21% VAT). This deposit will be deducted for your total hotel amount andbalance, the remainder of the money (after the deposit) will be taken from your Credit Card account on 28 February 2010.
Due to the limited number of rooms at the preferred hotels, we highly recommend that you make your hotel reservation at an early stage.
Room reservations will be confirmed on the "first come first serve" basis.
Cancellation will only be accepted in writing. For cancellations before 28 February 2010, 50% of the deposit will be charged. Hotel deposits are notrefundable if cancellations are made after 28 February 2010.

FIELD TRIPS
Destination

Price (per person)

FT-1 Yogyakarta - Borobudur - Dieng Plateau(3 Days and 2 nights, Date: 22-24 April 2010)

Twin Sharing: USD 605
Single Occupants : USD 680

FT-2 Manado - Lahendong(3 Days and 2 Nights, Date: 22-24 April 2010)

Twin Sharing: USD 868
Single Occupants : USD 1157

FT-3 Bandung - Wayang Windu(3 Days and 2 Nights, Date: 1-3 May 2010)

Twin Sharing: USD 605
Single Occupants : USD 697

FT-4 Jakarta - Gunung Salak( 2 Days and 1 Night, Date: 1-2 May 2010)

Twin Sharing: USD 535
Single Occupants : USD 570

Number of Person

Subtotal USDUSD

DAY TOURS
Destination

Price per Person

1. Denpasar, One City, Ten Markets (DT-1)

USD 22

2. Ubud, Between Tradition and Art (DT-2)

USD 32

3. Tanah Lot, the Unforgettable Bali (DT-3)

USD 32

4. Kecak Dance and Jimbaran Dinner (DT-4)

USD 66

5. Kehen, Panglipuran (DT-5)

USD 32

6. Mystery of Petanu River (DT-6)

USD 44

7. Bedugul, Land of Spices (DT-7)

USD 45

8. The Kingdom of Karangasem (DT-8)

USD 48

9. Besakih, Telaga Waja River (DT-9)

USD 87

10. Lembongan Catamaran Cruise (DT-10)

USD 150

11. Bedugul Geothermal Field Development (DT-11)

USD 36

Number of Person

USD

Subtotal USD

CANCELLATION
Total Amount for Accommodation

USD

Total Amount for Field Trips

USD

Total Amount for day Tours

USD

GRAND TOTAL AMOUNTUSDPAYMENT
I intend to pay by bank telegraphic transfer to :Pacto WGC 2010
Lippo Bank - Kuningan Lippo Life, Plaza Centris Lt. 1
Jl HR Rasuna Said Kav B-5, Kuningan, Jakarta 12910
Phone : 62-21-2524860 Fax : 62-21-2525070 / 71
A/C (USD) : 705 - 30 - 70810 - 4
A/C (IDR) : 705 - 30 - 09344 - 4
I intend to pay by credit card and here with authorize PACTO CONVEX Ltd. to charge the above amount by:
VisaMasterCard
Card number:

Expiry date:

Card holder name :Security number :(month/year)

Card holder Signature :Note :

Address:

Total Amount:

Date:

Should you pay by telegraphic transfer, the Conference Organizer must receive the FULL AMOUNT. For our reference and administration purposes, pleasecopy us the bank transaction and sent it by fax to (62-21) 7236193 and (62-21) 5705798 or email to hotel@wgc2010.org
Payment by credit card is normally charged in local currency. The committee takes no responsibility for subsequent exchange rates applied by credit card
vendors when your statement is converted into local currency

CANCELLATION FOR FIELD TRIPS AND DAY TOURS :Notification of cancellation must be sent to the Congress Secretariat. Cancellation for Field Trips and Day Tours will be accepted until 28 February2010 up to which date the total amount will be refunded. We regret that no refunds can be made after 28 February 2010.

PLEASE DO NOT FORGET TO TAKE A COPY FOR YOUR OWN RECORDS!

WGC2010

World Geothermal Congress
25 – 30 April 2010
Bali International Convention Centre, Nusa Dua
Bali - Indonesia

Please return the form to:Organizing Committee WGC2010
Grha Bimasena
Jl. Dharmawangsa Raya 39
Jakarta Selatan, Indonesia
Phone : +62-21 7258668
Fax: +62-21 7236193
E-mail : shortcourse@wgc2010.org
Website : www.wgc2010.org

SHORT COURSES REGISTRATION FORM
REGISTRATION NUMBER (Official use only)

PERSONAL INFORMATION (Please use BLOCK LETTERS)Mr.
First Name

Mrs.

Ms.

:

Last Name:

City:

Title (e.g. Prof., Eng., Dr., etc) :Company/Institution:

Position:

Address:

Post Code:State/Country :Telephone:

Fax:

Mobile Phone:

E-mail:SHORT COURSES (Please tick your choice)Registration Fees
1. Drilling, Completion and Testing of Geothermal Wells (2 Days Pre-conference Course) *USD 300

2. Geothermal Power Generation - Operation and Maintenance (2 Days Pre-conference Course) *USD 300

3. Geothermal Heat Pumps (2 Days Pre-conference Course) *USD 300

4. Financing Geothermal Projects (2 Days Pre-conference Course) *USD 300

5. Introduction to Geothermal Energy (2 Days Pre-conference Course) (Topic for Indonesian Audience)

USD 200* Course Fee USD 400 for Non-IGA Member or Participants from the countries other than A and B categories of World Bank (see list attached toRegistration fees table on this registration form, page 1)
Price above covers : Attendance to the course, CD and hard copy materials, other written materials, coffee break and lunch.
Note : Participants are expected to provide their own board and lodging.
Additional information can be get on shortcourse@wgc2010.org

PAYMENT
I intend to pay by bank telegraphic transfer to :Pacto WGC 2010
Lippo Bank - Kuningan Lippo Life, Plaza Centris Lt. 1
Jl HR Rasuna Said Kav B-5, Kuningan, Jakarta 12910
Phone : 62-21-2524860 Fax : 62-21-2525070 / 71
A/C (USD) : 705 - 30 - 70810 - 4
A/C (IDR) : 705 - 30 - 09344 - 4
I intend to pay by credit card and here with authorize PACTO CONVEX Ltd. to charge the above amount by:
Visa
MasterCard
Card number:Expiry date:

Card holder name :Card holder Signature :Note :

Security number :(month/year)

Address:

Total Amount:

Date:

Should you pay by telegraphic transfer, the Conference Organizer must receive the FULL AMOUNT. For our reference and administration purposes, please
copy us the bank transaction and sent it by fax to (62-21) 7236193 and (62-21) 5705798 or email to shortcourse@wgc2010.org
Payment by credit card is normally charged in local currency. The committee takes no responsibility for subsequent exchange rates applied by credit cardvendors when your statement is converted into local currency

I hereby authorize the Indonesian Geothermal Association to debit the above mentioned credit account with the total value of the items booked by meon this form.
I have read and agreed to the Disclaimer of Liability posted on the Congress website and agree to abide by decisions of the Organizers or persons
entrusted by the Organizers, with respect to operation of the Congress.

Signature :Date :CANCELLATION
If, after registering to attend WGC2010 and its associated activities you have to cancel your registration for any reason then it must be done in writing
to the Organizers, who must receive this notice before 28 February 2010. Refunds, less a US$ 100 administration charge, will be issued after theCongress. No refunds will be issued for cancellations received after 28 February 2010. Participants who register but do not attend the Congress, orattend only a part of the Congress, will be responsible for the full registration fee. Refunds of cancelled registration fees cannot be applied to future
World Geothermal Congress events.
Participants agree to abide by decisions of the Organizers, or individual persons entrusted by the Organizers, with respect to operation of theCongress.

PLEASE DO NOT FORGET TO TAKE A COPY FOR YOUR OWN RECORDS!

Please return the form to:Organizing Committee WGC2010
Grha Bimasena
Jl. Dharmawangsa Raya 39
Jakarta Selatan, Indonesia
Phone : +62-21 7258668
Fax: +62-21 7236193
E-mail : fellowship@wgc2010.org
Website : www.wgc2010.org

WGC2010World Geothermal Congress
25 – 30 April 2010
Bali International Convention Centre, Nusa Dua
Bali - Indonesia

FELLOWSHIP APPLICATION FORM (DEADLINE : 30 NOVEMBER 2009)REGISTRATION NUMBER (Official use only)

PERSONAL INFORMATION (Please use BLOCK LETTERS)Mr.
First Name

Mrs.

Ms.

:

Last Name

:

City:

Title (e.g. Prof., Eng., Dr., etc) :Company/Institution:

Position:

Address:

Post Code:State/Country :Telephone:

Fax:

Mobile Phone:

E-mail:Paper number:

Paper Title:

Company/Institution:

Address:
City:

Post Code:State/Country :Main work of Company/Institution :How related to geothermal / energy :Position and duties in the: Company/Institution :Do you have any partial support from other source?

yesnoif yes, amount in USD(People with partial support from other source will have a higher preference for WGC support)
Short Courses Planning to attend (Please refer to WGC 2010 website)
Fellowship Programme of previous Congress?

Signature:

SC-1

SC-2

SC-3

WGC 1995

Full

PartialNone

WGC 2000

Full

PartialNone

WGC 2005

Full

PartialNone

Date :

SC-4

SC-5