Registration Form (Online Payment)

Sustainability in the leather supply chain conference, 31 March 2016

	Single person	2nd, 3rd etc person of the same company
Standard Fee: BLC members / APLF Exhibitors:	US$385 US$355	US$370 US$340

The * items are required fields.

COMPANY CONTACT DETAILS

My organisation: *
Number of Delegate: *	Sustainability in the leather supply chain conference, 31 March 2016
Contact Person: *
	First Name Last Name
Job Title: *
Address: *
City:	State: Postal/Zip Code:
Country/Region: *
Contact Number:	Tel: Fax: Dir: *
	Country/Region City Local Country/Region City Local Country/Region City Local
Email: *
Web Site:

MEMBERSHIP

To enjoy the member rate, please check the appropriate item(s) you belong to

BLC members / APLF Exhibitors

DELEGATE DETAILS

Business Sector (Please check where appropriate) *	Delegate Profile (Please check where appropriate) *
Manufacturer	Manufacturer
Exporter	Exporter
Importer/Buying Office	Importer/Buying Office
Independent Wholesaler/Distributor	Independent Wholesaler/Distributor
Agent	Agent
Department Store/Chain Store	Department Store/Chain Store
Retailer	Retailer
Mail Order/e-tailer	Mail Order/e-tailer
Others	Others

Agreement of Terms and Conditions

Registration for the Conference is on a first-come-first-served basis. Official registration confirmation will be sent to the delegate's company by email or fax. Registration will only be confirmed upon receipt of full payment. The booking is non-cancellable and the fee paid is non-refundable. The organisers reserve the right to approve all registration.

I agree

<input type="hidden" name="_-txtUnderstandingLeather{index}" />
            <input type="hidden" name="_-txtMouldInLeather{index}" />
            <input type="hidden" name="_-txtProductSafety{index}" />
            <table class="detailTable" delegate="{index}">
                <tr>
                    <td style="padding-top:10px; width:140px;">Delegate {index}</td>
                    <td style="padding-top:10px;">
                        
					</td>
                </tr>
                <tr>
                    <td>First Name, Last name: <span class="red">*</span></td>
                    <td>
                        <span><select style="width:75px;" name="_-selTitle{index}" require="true" message="Please select the title!">{titleList}</select></span>
                        <span style="padding-left:10px;"><input type="text" maxlength="15" style="width:125px;" name="_-txtFirstName{index}" require="true" message="Please enter the first name!" /></span>
                        <span><input type="text" style="width:125px;" maxlength="15" name="_-txtLastName{index}" require="true" message="Please enter the last name!" /></span>
                    </td>
                </tr>
                <tr>
                    <td>Job Title: <span class="red">*</span></td>
                    <td><input type="text" style="width:348px;" maxlength="40" name="_-txtJobTitle{index}" require="true" message="Please enter the job title!" /></td>
                </tr>
                <tr>
                    <td>Email: <span class="red">*</span></td>
                    <td><input type="text" style="width:348px;" maxlength="50" name="_-txtEmail{index}" regex="/^([0-9a-zA-Z]+[-._+&])*[0-9a-zA-Z]+@([-0-9a-zA-Z]+[.])+[a-zA-Z]{2,6}$/" require="true" message="Please enter the email address!|Please enter the email address!|Email address format errors, please re-enter!" /></td>
                </tr>
                <tr>
                    <td>Tel: <span class="red">*</span></td>
                    <td>
                        <span><input type="text" style="width:80px;" maxlength="10" require="true" name="_-txtTelCountry{index}" regex="/^[0-9]*$/" message="Please enter the Telephone country code!|Telephone country code format can only be a number, please re-enter!" /></span>
                        <span><input type="text" style="width:123px;" maxlength="10" require="true" name="_-txtTelCity{index}" regex="/^[0-9]*$/" message="Please enter the Telephone city code!Telephone city code format can only be a number, please re-enter!" /></span>
                        <span><input type="text" style="width:124px;" maxlength="15" name="_-txtTelLocal{index}" require="true" regex="/^[0-9]*$/" message="Please enter the Telephone number!|Telephone number format can only be a number, please re-enter!" /></span>
                    </td>
                </tr>
                <tr>
                    <td> </td>
                    <td>
                        <span>Country/Region</span>
                        <span style="padding-left:46px;">City</span>
                        <span style="padding-left:110px;">Local</span>
                    </td>
                </tr>
                <tr>
                    <td>Company/Organisation: <span class="red">*</span></td>
                    <td>
                        <span><input type="checkbox" id="chkSameSaAbove{index}" name="_-chkSameSaAbove{index}" item="SAME_AS_ABOVE" value="Same as above" /> <label for="chkSameSaAbove{index}">Same as above</label></span>
                        <span style="padding-left:10px;"><input type="text" maxlength="50" name="_-txtOrganisation{index}" require="true" style="width:231px;" message="Please enter the company/organisation name!" /></span>
                    </td>
                </tr>
                <tr>
                    <td>Address: <span class="red">*</span></td>
                    <td><input type="text" style="width:348px;" name="_-txtAddress{index}" maxlength="340" require="true" message="Please enter the address!" /></td>
                </tr>
                <tr>
                    <td>City: </td>
                    <td>
                        <span style="padding-right:20px;"><input type="text" maxlength="40" style="width:100px;" name="_-txtCity{index}" /></span>
                        State:<span style="padding-left:10px; padding-right:20px;"><input maxlength="40" type="text" style="width:100px;" name="_-txtState{index}" /></span>
                        Postal/Zip Code:<span style="padding-left:10px;"><input type="text" maxlength="10" style="width:80px;" name="_-txtPostalCode{index}" /></span>
                    </td>
                </tr>
                <tr>
                    <td style="padding-bottom:10px;">Country/Region: <span class="red">*</span></td>
                    <td style="padding-bottom:10px;">
                        <select style="width:250px;" name="_-selCountry{index}" require="true" onchange="changeCountry({index});" message="Please select the country!">{countryList}</select>
                        <input type="hidden" name="_-txtCountryName{index}" />
                    </td>
                </tr>
            </table>