MEMBER
NAME
:___________________________ DESIGNATION _________________________________
COMPANY : ___________________________________________________________________________
ADDRESS : ___________________________________________________________________________
Tel : ______________________ Fax : ___________________________
E-mail: _____________________ Website : _______________________
Accompanying : Person
1) NAME : __________________________ Relationship ______________  Free entry
2) NAME : __________________________ Relationship ______________  USD : 500.00
Total amount paid :
_____________
NON - MEMBER
1) NAME : __________________________ Company ________________  USD : 1000.00
2) NAME : __________________________ Company _______________  USD : 1000.00.
Total amount paid :
_______________
PAYMENT BY : (please attach copy of payment details)
 CHEQUE : Cheque No ____________ Date ___________ Bank _______________ /
 CASH DESPOSIT : Date ___________ /
 BANK TRANSFER : Date ___________
ACCOUNT NAME
AED ACCOUNT NO
AED IBAN NO
ADDRESS OF BANK
BANK TRANSFER
:
:
:
:
BUREAU OF MIDDLE EAST RECYCLING
1021-011827-002
AE03 0460 0010 2101 1827 002
UNITED ARAB BANK, P.O. BOX 25022,
Sharjah Brach, UAE
:
Favor of :
DEUTSCHE BANK TRUST CO AMERICAS, NEW YORK
(SWIFT BIC: BKTRUS33)
for credit to : UNITED ARAB BANK, Sharjah Branch, UAE
(Swift code is UARBAEAA)
for final credit favoring A/C Name : BUREAU OF MIDDLE EAST RECYCLING
USD A/C No : 1021 011827 003 IBAN NO. AE73 0460 0010 2101 1827 003
NOTE :
• Member : Two attendees free and US$ 500/- per head for additional attendees.
• NON Members : Delegate fee: US$ 1,000/- per head
_______________________________
SINGNATURE
________________________
DATE
(KINDLY EMAIL THE DULY FILLED IN APPLICATION FORM ALONG WITH THE PAYMENT
DETAILS TO [email protected]/ [email protected] )

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