HELIUM SUPER SUMMIT 2021 

Adjusting to the Change in Helium Supply Dynamics  

HOUSTON | DECEMBER 7 – 9

Delegate Booking Form

We are delighted you will be joining us for our upcoming Super Summit. To enable us to process your booking, please fill in all of the fields below.  

Company Information:
Company Name
Company name as you would like it to appear on event material
Company Address
Country
Region
Postal/Zip code
VAT/TAX code
Point of contact for booking (for liaising and confirming booking):
Point of contact name
Email
Delegate One:
Delegate Two:
First Name
Family Name
First Name
Family Name
Name as you would like it to appear on delegate badge
Name as you would like it to appear on delegate badge
Job Title
Seniority Level
Job Title
Seniority Level
Email
Phone
Email
Phone
Please tick here if you do not wish your email to be distibuted to other delegates
Please tick here if you do not wish your email to be distibuted to other delegates
Delegate Three:
Delegate Four:
First Name
Family Name
First Name
Family Name
Name as you would like it to appear on delegate badge
Name as you would like it to appear on delegate badge
Job Title
Seniority Level
Job Title
Seniority Level
Email
Phone
Email
Phone
Please tick here if you do not wish your email to be distibuted to other delegates
Please tick here if you do not wish your email to be distibuted to other delegates
Event Attendance:
So that we are able to accommodate for numbers, please let us know which functions you will attending:
Please let us know of any dietary requirements, eg. vegetarian, halal or vegan.*
*Please note that some meals may incur an extra cost as we will need to order specially.
How would you like to receive your Delegate Manual?
Payment:
Please choose your ticket option
Early Bird $1200
I would like to be invoiced
Total Amount:
Please sign below to say you have read the terms and conditions here. Terms & Conditions
Signed:
Date:
Please note: Delegates must have paid before attending the summit. Failure of payment will result in entry refusal on the day.
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