Registration Form

2 Participant Registration Form Please return to the Conference Secretariat:E-mail: lr2012@iclei.orgFax: +49-761/368 92 29Completing all fields (including fee) is required. Mr FORMCHECKBOX ? Ms FORMCHECKBOX ? Title _________________First name Last name Organisation (in your language) Organisation (in English)* Title/Function and Department (in your language) Title/Function and Department (in English)* *(The English organisation/function as indicated here will appear on your conference badge. 40 characters max.)Street Postal / Zip code City Country Phone (country code/city code/phone number) (country code/city code/fax number)Mobile (for being reached during the conference)E-mail Website Special needs: FORMCHECKBOX ? Vegetarian meals FORMCHECKBOX ? Wheel chair access FORMCHECKBOX ? Other special needs FORMCHECKBOX ? I register for the Local Renewables Conference Freiburg 2012, 25-26 October 2012 in Freiburg im Breisgau, Germany. I agree to be included in the participants list. FORMCHECKBOX ? I wish to receive an official invitation letter in support of my VISA application for Germany. Registration fee FORMCHECKBOX ? Business fee 470 Euro per person FORMCHECKBOX ? Standard fee 370 Euro per person FORMCHECKBOX ? Reduced fee* 280 Euro per person*The reduced fee is applicable to representatives who fall into one of the following categories. Please tick the relevant box: FORMCHECKBOX ? ICLEI member FORMCHECKBOX ? CCP participant FORMCHECKBOX ? Local Government of a new Member State, an accession or a candidate country of the European Union FORMCHECKBOX ? Local Government of a Developing Country FORMCHECKBOX ? Student fee (up to 25 yrs of age) 150 Euro per person FORMCHECKBOX ? No fee, as agreed in previous communication (please specify): FORMCHECKBOX ? I will make the bank transfer to the account listed below.Please note that a very late registration might not allow us to include your name on the official participants list and conference materials may only be provided at a later date. Parallel Workshops – Indicate you interests Thursday 25 October 2012 (14:00-15:30): FORMCHECKBOX ? Session A1 – Building a smart grid: First lessons from practical experiences FORMCHECKBOX ? Session B1 - Urban-regional cooperation for renewable energy Thursday, 25 October 2012 (16:00-17:30): FORMCHECKBOX ? Session A2 – Decentralised energy production, centralised management and storage FORMCHECKBOX ? Session B2 – Exploring policy needs to support deployment – “Smart grids in practice” Networking event hosted by the City of Freiburg at the Historisches Rathaus, on Thursday 25 October 2012, starting at 19:00. FORMCHECKBOX ? I will attend FORMCHECKBOX ? I will NOT attend Study tours will be organised by the City of Freiburg and take place on Friday 26 October 2012 afternoon. More information available at www.local-renewables-conference.org/freiburg2012 FORMCHECKBOX ? T1 Hanisenhof - 100% sustainable farm FORMCHECKBOX ? T2 Wind, water, wood : Freiburg’s renewable energy at a glance FORMCHECKBOX ? T3 Redevelopment of Freiburg’s neighbourhood Weingarten FORMCHECKBOX ? I will NOT attend any study tour TI LanguageEnglish will be the conference language. Language support may be offered if there is sufficient interest and require an additional fee. A translator travelling with a delegation has free access to the conference.Please indicate your preferred language: FORMCHECKBOX ? English FORMCHECKBOX ? French FORMCHECKBOX ? German FORMCHECKBOX ? Spanish FORMCHECKBOX ? Italian FORMCHECKBOX ? Other: Remarks: Where did you learn about the Local Renewables 2012 Conference? Please choose one of the following options: FORMCHECKBOX ? conference website FORMCHECKBOX ? direct emailing FORMCHECKBOX ? other, please specify: _____ I hereby register as a participant for the Local Renewables Freiburg 2012 Conference, 25 – 26 October 2012Date Registration and confirmation informationConference fees: Deadline for official registration is 15 September 2012. Places are limited. Please note that participants who wish to register after 15 September 2012 will be subject to a 50 Euro charge in addition to the applicable registration fee.The conference fee covers admission to the event, participation in all sessions, including workshops and study tours, conference materials, lunches, coffee breaks, one evening reception. Accommodation is not included in the registration fee. We recommend you to make the necessary accommodation arrangements as soon as possible. Cancellation / Substitution: You may cancel your registration at no extra cost if written notice of cancellation is received by the conference secretariat before 15 September 2012. The bank charges for the reimbursement of the fee will have to be covered by the participant. Cancellations received after this date may be charged a cancellation fee of 50 Euro. Paid registrations may be transferred to a substitute participant without additional cost. In this case, please inform the secretariat in writing. The substitute participant should register as well.Liability: The programme and speakers are subject to change. Should the conference be cancelled due to force majeure, unavailability of the conference venue, speakers being prevented or else, the organiser reserves the right to cancel the conference. In case of cancellation all participants will be promptly informed. The cancellation due to low attendance will not be made later than two weeks prior to the conference. In this case, all registration fees will be reimbursed.Payment details for participants: Full payment is required in order to confirm registration. A confirmation of payment will be sent via email (please note however that payment receipts will only be issued upon request). Please pay via bank transfer, ensure that all bank fees are covered and that the applicable funds are transferred to: Account holder: ICLEI European SecretariatAccount No.: 12 54 87 45Address of Account Holder: Leopoldring 3 D-79098 Freiburg, GermanyNational bank code: 6809 0000 Name of Bank : Volksbank FreiburgAddress of Bank: Bismarckallee 10 D-79098, Freiburg, GermanyBIC / SWIFT Code: GENODE61FR1IBAN-Code: DE42 6809 0000 0012 5487 45Do not forget to include "Participant's name, LR2012 – fee" in the transfer. If the bank transfer is made for several people, please make sure you either list them or inform the conference secretariat by fax (include copy of bank transfer sheet and list of names).??Conference Secretariat ICLEI Europe Strategic ServicesLeopoldring 3 D-79098 Freiburg im Breisgau, Germany Tel: +49-761 / 3 68 92-20Fax: +49-761 / 3 68 92-29E-mail: LR2012@iclei.org?Thank you for your time and your registration for the conference.Please visit the conference website for regular updates www.local-renewables-conference.org/freiburg2012/