hotel reservation form

The 9th WORLD CONGRESS on BLUE ECONOMY – 2015
DELEGATE REGISTRATION FORM
*indicated required field – please complete
Date :
This form enables you to:
 Register to attend WCBE 2015
 Indicate attendance at the conference
Important notes
 Please send all pages to WCBE 2015 Secretariat
 Please keep a photocopy for your record. One form per person
Please complete and return by email or fax to:
WCBE 2015 SECRETARIAT
Phone: +62 21 3001 6005 / +62 878 77216902
Fax: +62 21 3001 6003
Email: [email protected] /
[email protected]
CONTACT DETAIL
 Mr.  Mrs.
Last Name*
Organization*
Position
Nationality*
Address*
Suburb/Town*
State*
Work phone
Email*
 Ms
 Miss
 Dr
 Prof.
First Name*
Other (please specify):
Country*
Work Fax
Postcode*
Mobile
Name Badge: Please indicate correct details for your name badge at the conference, if different from above
First Name*
REGISTRATION FEE
Early Bird
Registration Fee
International Delegate
Accompanying Person
Local Delegate
Student
Last Name*
Organization
Standard
On or Before February 2015
After
February 2015
US$ 500
US$ 600
Rp. 3.500.000
Rp. 4.000.000
US$ 200
Rp. 1.000.000
9th WORLD CONGRESS BLUE ECONOMY – 2015
US$ 300
Rp. 1.500.000
PAYMENT
 I intend to pay by bank telegraphic transfer to:
Yayasan Ekonomi Biru
BCA KCP Setiabudi Atrium
Jl. HR. Rasuna Said, Jakarta 12940
A/c No. (IDR) 766 0336120
A/c No. (USD) 766 0364409
Note:
• Should you pay by telegraphic transfer, the Organizer must receive the FULL AMOUNT. Please copy us the bank
transaction and sent it by fax to (62-21) 3001 6003 to avoid problems.
• Payment by credit card is normally charged in local currency. The host committee takes no responsibility for
subsequent exchange rates applied by credit card vendor after your departure, when your statement is converted
into local currency.
CONFIRMATION OF ATTENDANCE
By registering, you will be able to attend any or all of the events listed below.
Please tick the appropriate boxes to indicate which events you may wish to attend.
Field Trip
 Mangrove Site, Pasuruan, East Java
 Ubaya Training Centre, Trawas, East Java
15 April 2015
 I have read and understood the terms & conditions.
Signature : ________________________________________________
Privacy Statement
9th WORLD CONGRESS BLUE ECONOMY – 2015
THE 9th WORLD CONGRESS ON BLUE ECONOMY, APRIL 2015
Day 1
Monday, 13 April 2015
Time
08.00-09.00
09.00-09.15
09.15-09.30
09.30-10.00
10.00-10.45
10.45-11.15
11.15-12.00
12.00-13.30
13.30-14.30
14.30-14.45
14.45-16.30
Agenda
Registration
Welcoming Speech
Report on the Blue Economy
Foundation and Congress
Key Note Speech:
Coordinating Minister of Maritime
Affairs
Zero Emission Research and
Initiative (ZERI)
Policy Session:
Ministry of Maritime Affairs and
Fisheries (KKP)
State Ministry of National
Development Planning (BAPPENAS)
Group Photo and Coffee Break
Policy Session:
Ministry of Tourism
Ministry of Research, Technology
and Higher Education
(Kemristekdikti)
Agency for Meteorology Climatology
& Geophysics (BMKG)
Lunch
Practical Issues :
Comprehensive Understanding of
the Blue Economy Initiative
Seaweed Farming
Mangrove cultivation
Coffee Break
Shrimp Farming
Capture Fisheries
16.30-17.00
19.00-21.00
Weather and Climate Information
and Prediction Provision in
Supporting the Blue Economy
Nile Tilapia
Discussion
Welcoming Dinner
Speaker
Moderator
Provincial Government
Dr. Sri Woro B. Harijono, M.Sc
Prof. Dr. Indroyono Soesilo,
MSc, APU
Prof. Dr. Gunter Pauli
Dr. Andi Eka Sakya,
M.Eng
Wendy Aritenang,
Ph.D
Dr. Sunoto, MES (KKP)
Dr. Nani Herdianty
Susilo Adi (Bantul Community)
Dr. H. Endang
Suhaedy, APi, MM,
MSi
PT. Agarindo Bogatama
Dr. H. Endang Suhaedy, APi,
MM, MSi (APS-KKP)
Ministry of Maritime Affairs and
Fisheries (KKP)
Prof. Edvin Aldrian (BMKG)
Dr. Ir. Retno Dumilah Esti
Widjayanti (BPPT)
The 9th World Congress Blue Economy 2015
Promoting Blue Economy in Community Participatory Based- industries For Poverty Eradiction.
Day 2
Tuesday, 14 April 2015
Time
08.00-09.00
09.00-10.20
10.20-10.40
10.40-11.00
11.00-12.00
12.00-12.30
12.30-14.00
14.00-15.00
15.00-15.15
15.15-16.15
16.15-16.45
16.45-17.15
17.15-17.30
19.30-21.00
Agenda
Speaker
Moderator
Registration
Success stories and lessons learnt from the Blue Economy based-industries:
Fish farming
Prof. Li Kangmin (Asian Pac
Prof. Edvin Aldrian
Regional R&T for Integrated Fish
Farming)
Algae
Prof. Dr. Jorge Alberto Vieira
Costa (Universidade Federal do
Rio Grande)
Mining waste conversion
Prishani Satyapal (Sustainability
Truthing)
Discussion
Coffee Break
Success stories and lessons learnt from the Blue Economy based-industries:
Overseas Speaker
Ubaya activities
(NN)
Discussion
Lunch
Funding support toward commercial level :
Banking
Dr. Moh. Indrawan
Dr. Sri Woro B.
Harijono
Prof. Gunter Pauli
Closing of the Congress
Farewell Dinner
Field Trip
Agenda
- Pasuruan: Mangrove and Crab practices
- Trawas: Training Centre & Social Participatory
Practices
Note : The Organizer reserves the right to amend the program
Dr. Ardhasena
Sopaheluwakan
Dewi Smaragdina,
SE,M.Sc
KADIN (Indonesian Chamber of
Commerce & Industry)
MAPPI (Indonesian Society of
Appraisers.
Coffee Break
(NN)
(NN)
(NN)
Discussion
Recommendation of the Congress
Day 3
Wednesday, 15 April 2015
Time
08.00-16.00
Yuko Tomizuka, MAI (Appraisal
Institute)
University Surabaya
Host
Sidoarjo Marine and Fisheries Polytechnic
(APS-KKP)
Surabaya University (UBAYA)
The 9th World Congress Blue Economy 2015
Promoting Blue Economy in Community Participatory Based- industries For Poverty Eradiction.
HOTEL RESERVATION FORM
The Organizing Committee has appointed official hotels for delegates at conference rates with a free shuttle service from official hotel –
venue – hotel. Please fill in this form in BLOCK LETTERS and send this form directly to the contact number/email address of your
preferred hotel and a copy to (62-21) 30016003 or [email protected] / [email protected] for shuttle
service arrangement. All payment for accommodation should be made in full amount and directly to your preference hotel.
Registration No:
DELEGATE INFORMATION
Full Name (as per-passport)
:
Company
:
Job Title
Address
:
Mr.  Ms./Mrs.
:
City
:
Post Code :
Phone
:
Fax:
Country
Email
Website
ACCOMPANYING PERSON
Full Name (as per-passport)
Job Title
HOTEL RESERVATION
HOTEL (Please )
 Novotel Surabaya Hotel
www.novotel.com
www.accorhotels.com
(venue of the congress)
:
:
:
:
:
ROOM CATEGORY
Superior Garden View
Superior Pool View
Superior Pool Terrace
Junior Suite
Per Room Per Night inclusive
breakfast
USD
IDR
 803.000,-*




868.000,-**
904.000,-*
969.000,-**
953.000,-*
 1.018.000,-**
 1.203.000,-*
 1.268.000,-**
Note
Included 21% service charge and
prevailing government tax
* Breakfast Included for 1 person
** Breakfast Included for 2 persons
HOTEL (Please )
Per Room Per Night inclusive
breakfast
USD
IDR
 1.709.000,-*
ROOM CATEGORY
Executive Suite
 1.774.000,-**

Suite 1 Bed

www.bumisurabaya.com
 Santika Hotel
www.santika.com
853.000,-*
918.000,-**
 1.334.000,-*
Suite 2 Bed
 Bumi Surabaya Hotel
Note
 1.399.000,-**
Suite 3 Bed
Deluxe Tower Room
 170
Executive Club Suite
 810
The Club Room
 190
Junior Club Suite
 610
Penthouse
 1.600
Deluxe Executive
Premiere
Junior Suite
 1.599.000,-*
 1.664.000,-**
 1.600.000, 1.900.000, 6.600.000, 7.600.000, 16.600.000, 715.000, 825.000,-
 1.100.000,-
Suite
NOTES: IDR Rate only valid for local delegates or KITAS/KIM Holder
Check-in Date (dd/mm/yy)
: _____________________________
Check-out date (dd/mm/yy)
: _____________________________
Total nights
: _____________________________ nights
Excluded 21% service charge and
prevailing government tax
Included 21% service charge and
prevailing government tax
 1.375.000,-
FLIGHT SCHEDULE
Arrival Date (dd/mm/yy)
Departure Date
(dd/mm/yy)
Time
Time
Flight No.
Flight No.
TERMS OF PAYMENT
• All booking will be based on first come first serve basis
• Full Payment is required upon reservation to confirm the booking
• Any cancellations and booking changes should be sent in writing by fax directly to the Hotel Contact listed (special
condition shall be applied)
• Payment by credit card is normally charged in local currency. The subsequent exchanges rates might be applied by the
credit card vendors, when your statement is converted into local currency
SETTLEMENT
Total
: __________ night(s) x USD / IDR ____________________ = USD / IDR ___________________________
Credit Card:  AMEX (4 digits security number: .................)  VISA  Master Card
Name of Cardholder
: ____________________________________________________
Card Number
: ____________________________________________________
Signature
: ____________________________________________________
Expiry Date
: ____________________________________________________