Should you need assistance, please call EPTDA Bureau at +32 2 709 22 12

EPTDA THANKS ITS AMBASSADORS! EPTDA is offering the following INCENTIVE SCHEME to the EPTDA members who support the Association's membership growth. For every new member they recruit: EPTDA Distributor Members will be offered a free registration for their spouses at the Annual Convention, or a 30% discount on the first delegate registration fee (this incentive is not time-limited and benefits can be accumulated for multiple referrals). EPTDA Manufacturer Members will be granted a free MD-IDEX table at the Annual Convention (this incentive is not time-limited and benefits can be accumulated for multiple referrals)

CHOOSE YOUR MEMBERSHIP TYPE

PLEASE USE ONE FORM PER DELEGATE
Please select your membership type from the menu:	EPTDA Distributor EPTDA Manufacturer EPTDA Associate PTDA Manufacturer PTDA Distributor PTDA Associate I am not a member of EPTDA

BEST EPTDA PROMOTER AWARDS

Run for the best EPTDA Promoter Awards in your EPTDA membership category - Distributor, Manufacturer or Associate - by helping to promote EPTDA in the industry. The prizes will be awarded during the EPTDA Annual Business Meeting on Thursday, September the 27th 2012, in Lisbon.

I display the EPTDA Member logo on my company's corporate website : YES NO

Download the EPTDA member logo from the EPTDA Members Area, by logging into http://www.eptda.org/Members-area/EPTDA-logos

DELEGATE DETAILS

Delegate details (All fields are required)
Mr. Mrs. Ms.
First name	Last name
Job title	Email
Spouse/Partner information
First name	Last name	Email (optional)
Company information (All fields are required)
Company name		Company VAT number
Company address
Post code	City	Afghanistan Albania Algeria Andorra Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands (The) New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Country
Phone	Fax
Website
Other information
No requirements Vegetarian Allergies Dietary Requirements for Delegate	No requirements Vegetarian Allergies Dietary Requirements for Spouse/Partner

ALL PRICES ARE PER PERSON/UNIT AND EXCLUSIVE OF VAT

DELEGATE & SPOUSE/PARTNER REGISTRATION

* Delegate registration includes attendance at all educational sessions, EPTDA Distribution Forum, access to the MD-IDEX and Open MD-IDEX sessions (EPTDA manufacturer members and all distributors), the Convention Welcome Reception & Dinner, Networking Breaks, lunches and Gala Dinner at Convento do Carmo. * Spouse/Partner registration includes participation in the Convention Welcome Reception & Dinner, Opening Keynote Address, Gala Dinner at Convento do Carmo. Spouse/Partner registration does not include access to the other parts of the delegate programme and lunches. * Member rates are valid for both EPTDA and PTDA members.
Register early - before July 6th - and save 10%!
			Total
	1st Delegate Registration	1050€ -> "Early-bird" fee : 950€
	Spouse/Partner	350€
TOTAL :			€
YES NO	I/we will / will not attend the VISIT AND GALA DINNER on Friday, 28 September 2012 at Convento do Carmo in Lisbon. Note: participation fee is included in the delegate and spouse/partner registrations

EPTDA GOLF TOURNAMENT

The 2012 EPTDA Golf Tournament will be hosted at the Penha Longa golf resort, one of Europe's most reputable golf parks. The tournament will run on the Atlantic Course, an 18-hole, par 72, championship course of 6,290 meters.
Date	Event	Price per person	Who will attend	Total
Tuesday, 25 Sep 09:00 - 18:00	GOLF TOURNAMENT (including green fee, golf set, transportation and light lunch)	150€	Delegate Spouse/Partner
TOTAL :				€

SOCIAL PROGRAMME

Pre-booking is required for all social events. Please make sure to register before 15 July, 2012.
Date	Social events	Price per person	Who will attend	Total
Thursday, 27 Sep 08:45 - 10:15	OPENING KEYNOTE ADDRESS * Allan Pease Communicating for results	FREE	Delegate Spouse/Partner
Thursday, 27 Sep 14:30 - 17:00	DISCOVERING LISBON INSIDE & OUT	50€	Delegate Spouse/Partner
Friday, 28 Sep 08:30 - 12:00	AN ENCHANTED VISIT TO SINTRA	75€	Delegate Spouse/Partner
Friday, 28 Sep 14:00 - 17:00	BELEM QUARTER AND THE DISCOVERIES	40€	Delegate Spouse/Partner
Saturday, 29 Sep 08:30 - 16:30	THE BEAUTY OF THE SOUTH OF THE RIVER (including lunch, visit to wine cellars & craft workshops)	115€	Delegate Spouse/Partner
TOTAL :				€
* Spouses are welcome to participate in this year’s Opening Keynote Address.

EPTDA DISTRIBUTION FORUM (complimentary)

"Fostering new ideas, best practices and ways to achieve better results" After a successful "premiere" at the EPTDA Budapest 2011 convention, the EPTDA is bringing again its exclusive Distribution Forum: a unique professional discussion forum for distributors and manufacturers in the power transmission and motion control industry. The 2012 Distribution Forum will increase PT/MC professionals’ insight into stopping margin erosion, succession planning for employees and diversification as a growth strategy. This special feature is free of charge.

YES NO

I will / will not attend the EPTDA Distribution Forum on Thursday, 27 September 2012 from 15:00 to 17:00.

NEXT GENERATION CONTEST AND FORUM

Wednesday, 26 September 2012, 22:30 : 00:00 For more information, click here

YES, I am a Next Generation representative (45 years old or below) and will participate in the Next Generation Contest and Forum NO, I am not a Next Generation representative but would like to join the Next Generation event as from 23h NO, I am not a Next Generation representative and I will not join the Next Generation event as from 23h

CHARITY DONATION *

The EPTDA makes ethical business one of its priorities, supporting the welfare of society. Continuing its charitable commitment, the EPTDA in 2012 partners with the ABCREAL Portugal Association. ABCREAL Portugal is a Social Alliance that is responsible for the implementation of the first Behaviour Intervention Centre in Portugal providing therapy methods for autistic children and youngsters. * Charity donations are VAT exempt and fiscally deductible in most countries. For more information, visit http://www.eptdaconvention.org

donation :

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MARKETING CODE

If you benefit from a special offer, please enter your Marketing Code. Please note that the code will be applied on the next page of the registration, after clicking "Preview before register"
marketing code :

GRAND TOTAL

ALL PRICES ARE EXCLUSIVE OF VAT

TOTAL Delegate & Spouse/Partner Registration				€
TOTAL EPTDA Golf Tournament				€
TOTAL Social programme				€
TOTAL EPTDA Distribution Forum			0	€
TOTAL Next Generation Contest and Forum			0	€
TOTAL				€
Portuguese VAT 23%				€
TOTAL Charity Donation (VAT exempt)				€
GRAND TOTAL =				€