Registration Form

Registration Form
SEMI SEA - Fundamentals of IC Packaging Seminar 2014
SEMI SEA – Fundamentals of IC Packaging Seminar
30-31 October 2014, MIDA HQ Building, Kuala Lumpur, Malaysia
Upon completion, please email or fax to :SEMI Southeast Asia
Email: [email protected]
Fax No.: +65 6339.6637 Tel: +65 6339.6361
Attention : Ms Linda Tan
Registration Profile (You must complete this section to receive an admission badge)
Delegate Information
1. Please indicate your level of management or supervisory responsibilities. (Select one)
*Salutation
□ 01 Executive Management (Chairman,
□ 02 Senior Management
President, Chief, Managing Director, etc.)
(Vice President / Director)
□ 03 Other
□ 04 Non-management
Management
□ 05 Other:
(Staff / Professional)
(Includes Trainee)
2. Please indicate your primary job function. (Select one)
*First (Given) Name
*Last (Family) Name
□ 10 Executive Management / Board Member
□ 32 Fabrication and Process Engineering
□ 11 Facilities Engineering /
Engineering Support
□ 29 Human Resources Mgmt
□ 16 Mfg. Engineering / Operations Mgmt.
□ 34 Assembly / Packaging Engineering
□ 17 Marketing, Sales, Business Developmt
□ 12 Financial / Industrial Analyst
□ 44 Product Management / Engineering
□ 23 Quality Assurance & Test Engineering
□ 28 Manufacturing and Production
□ 27 Training
□ 63 Design Engineering (incl. Software,
□ 24 Research & Developmt Engineering
□ 09 Environment, Health & Safety
□ 99 Other: (Please describe)
□ 22 Purchasing / Procurement
□ 13 Government / Public Policy
Systems, Test, Hardware)
*Job Title
3. Which of the following best describes your company? (Select one)
□ 210 PC / Consumer / Commercial
*Company Name
Electronics Manufacturer
*Company Address
*City
State
*Postal Code / Zip
□ 220 Electronic Manufacturing
Services (EMS) Provider
□ 018 Photovoltaic / PV Cells and
Modules Manufacturer
□ 230 Electronics Distributor / Reseller
□ 010 Semiconductor Device
Manufacturer (IDM, foundry)
□ 014 MEMS / MST / Micromachines Mfr
□ 013 Fabless Semiconductor
Manufacturer / Design House
□ 012 Assembly & Test Services Provider
□ 024 Semiconductor Equipmt Mfr
□ 015 Flat Panel Display Manufacturer
□ 041 Sub-systems / Components /
Parts Manufacturer
*Country
*Tel (Country/Area Code/Number)
Fax (Country/Area Code/Number)
□ 016 LED / Optoelectronics /
Photonics Manufacturer
□ 036 Materials Supplier
□ 085 R&D / Academic / Professional
□ 050 Software – Electronic Design (EDA) /
Silicon Intellectual Property (IP)
□ 060 Software – Manufacturing/
Factory Automation
□ 087 Media / Publication
□ 073 Secondary Equipment and Services
□ 090 Manufacturing Products / Consumables
□ 070 Manufacturing Services and Consulting
Organisations and Institutions
□ 103 Construction /
Construction Services
□ 083 Finance / Investmt Pdts / Services
□ 999 Other: (Please describe)
□ 080 Professional Services and Consulting
4. Please indicate the technology areas or segment in which you are interested. (Select all that apply)
□ 610 Semiconductors
□ 617 Flexible / Printed Electronics
□ 614 MEMS
□ 618 Photovoltaic / PV
□ 615 Flat Panel Display
□ 619 Nano-electronics
□ 616 LEDs/ Solid State Lighting
□ 699 Other: (Please describe)
*Mobile (Country/Area Code/Number)
5. Please select the product/technology categories of interest to you. (Select all that apply)
MANUFACTURING EQUIPMENT
MATERIALS
SOFTWARE, OTHER PRODUCT
AND SERVICES
*Email (Receive confirmation letter by email)
□ 024-00 Wafer Processing/Front-end
Manufacturing Equipment
Website
□ 022-01 Thin Film Mfg Equipment
□ 025-00 Test Equipment
30-31 October 2014 (Thurs – Fri)
SEMI Member
Non-Member
□
□
RM1300 per pax
RM1500 per pax
□ 021-00 Assembly and Packaging Equip.
□ 023-00 Inspection & Measurement/Metrology
Products
□ 026-00 Other Equipment
□ 037-00
□ 036-00
□ 032-00
□ 033-00
Wafers and Substrates
Process Materials
Chemicals & Solids
Gases
□ 038-00 Test Materials
□ 031-00 Assembly & Packaging Materials
□ 039B-00 Other Materials
□ 040-00
□ 045-00
□ 050-00
□ 063-00
Sub-Systems
Component Parts & Accessories
Factory Control Automation
Software – Electronic Design/
Silicon Intellectual Property (IP)
□ 070-00 Manufacturing Services or
Consulting (incl. those service or
consulting directly related to
manufacturing)
MANUFACTURING
□ 210-00 Electronic Manufacturing Svcs
□ 010-00 Semiconductor Device Mfg.
(IDM, Foundries)
□ 013-00 Fabless Semiconductor Mfr/
Design Services
□ 012-00 Assembly & Test Services
Special dietary Request
Vegetarian
□ 080-00 Business Services or Consulting
□ 099-00 Other: (Please describe)
□
 Programmes and timings are subject to change without prior notice.
Applicable to Malaysian companies only
 Course fee will be debited from Human Resources Development Fund (HRDF) employer’s account.
 Registered employers will be given 100% financial assistance (subject to terms and conditions).
6. Would you like to receive information on SEMICON Southeast Asia 2015 Penang ? (Select one)
□ Yes
□ No
IMPORTANT:

Limited seats are available. Registration based on first-come-first-serve basis.

Upon receipt of registration, participant will receive email confirmation within a week.

Course fee must be made prior to the event to SEMI Singapore Pte Ltd via bank draft/cheque.

No cancellation is allowed once registered. Replacement of participant is permitted with authorisation letter.
SEMI SEA - Fundamentals of IC Packaging Seminar 2014
PAYMENT INFORMATION FORM
Please m ar k o n e o f t h e 3 p aym en t o p t io n s r ef er en ced b elo w an d co m p let e t h at r elat ed sect io n .
Registration from individuals/companies with delinquent balances due SEMI will not be processed. No
cancellation is allowed once registered. Replacement of participant is permitted with authorisation letter.
 1.
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Co m p an y Nam e:_________________________________________________________________
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r ever se sid e o f yo u r ch eck) an d sen d t o :
SEMI Sin g ap o r e Pt e Lt d .
161 Laven d er St r eet #04-04
Sin g ap o r e 338750
Ph o n e: + 65.6339.6361 Fax: + 65.6339.6637
 2.
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 3.
PAYMENT BY CREDIT CARD (We accept VISA, Mastercard Only)
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Please return this completed form with your registration form by fax to
+65.6339.6637 (SEMI Singapore Office) or email to [email protected]