EPCglobal / RFID Forum 2005
Wednesday, 8 June 2005

Grand Copthorne Waterfront Hotel

2 ways to register:

1. Mail this form with payment by local cheque or bank draft to Ms Ivy Teng, GS1 Singapore, The Enterprise #02-02 No. 1 Science Centre Road, Singapore 609077

2. Fax this form with credit card payment to fax: 65-68228 318

Registration Form

We, __________________________________________________ (name of company), are interested to participate in the above-mentioned EPCglobal / RFID Forum 2005.

Our company representative(s) participating in the Forum include(s):

Name Designation

Mr/Ms_______________________________ _______________________________

Mr/Ms _______________________________ _______________________________

Mr/Ms_______________________________ _______________________________

Method of Payment:

£ We enclose our Cheque No. ________________ for *S$ ____________ (payable to

"SMA-GS1 Singapore Council") in registration of ________ participant/(s).

£ By Credit Card

Payment Declaration:

I hereby authorize GS1 Singapore to debit my Credit Card account for the amount *S$/US$____________ in registration of ________ participant/(s).

Credit Card Type £ Visa £ MasterCard £ Amex £ Diners

Credit Card No.__________________________________ Expiry Date _____________________

Card Holder’s Name ______________________________ Signature _______________________

Registration Fee:

— S$170.00 (inclusive of GST) per GS1 Singapore / SMa member

— S$850.00 (inclusive of GST) per non member

— US$100 per ISO delegate

________________________________ __________________________________

Signature (with company stamp) Name of Signatory

Company's Address: _____________________________________________________________

E-mail _____________________________ Tel: _________________ Fax: __________________

Contact person: _________________________________________________________________