REGISTRATION FORM (43 1) 712 41 65 (43 1) 714 67 69 Fax Back To: Marizel Aguirre, Client Relations Executive on (43 1) 712 41 65

Five easy ways to register 1. Fax REGISTRATION FORM (43 1) 712 41 65 (43 1) 714 67 69 Fax back to: Marizel Aguirre, Client Relations Executive on (43 1) 712 41 65 ρ Yes, please register me and/or my colleague(s) for The Ninth Business Roundtable 2. Telephone with the Government of Poland, April 16th, The Westin, Warsaw (43 1) 712 41 61 41 and return this form to confirm your registration A Delegate details 3. Online (Please photocopy this form to register more than one delegate) Our Ref: PAIZ Register online at: Surname (Dr/Mr/Mrs/Ms): www. economistconferences.com First name: __________________________________________________________ 4. E-mail Job title: ____________________________________________________________ E-mail your details to: [email protected] Region of responsibility: ρ Global ρ EMEA ρ CEEMEA ρ CEE ρ EU ρPoland Company: __________________________________________________________ 5. Post Post the completed form Company VAT No.:____________________________________________________ with your payment details to: Nature of business: ___________________________________________________ Marizel Aguirre Economist Conferences Address: ___________________________________________________________ Öelzeltgasse 3/7 Town/city: __________________________________________________________ 1030 Vienna, Austria Postcode: Country: NB: Delegate fee(s) must be paid in full prior to the event. Tel: Fax: E-mail: _____________________________________________________________ Substitutions/cancellations If you are unable to attend the conference for any reason, you may make B Pricing details and special offers substitutions at no extra charge but we would appreciate prior notice. If you wish Standard delegate fee (including documentation): EURO 1,750 per person to cancel your booking we require at least EURO 200 discount when two or more delegates from the same company register together. 21 days' prior written notice. If you cancel at least 21 days prior to the conference an Discounts cannot be combined. administration fee of 20% will be payable. If full payment has already been made, C Payment details the balance (less the administration fee) will be refunded. I wish to register (number) delegate(s). If your cancellation notice is NOT received at least 21 days prior to the day of the conference, you will be liable for Total amount (EURO): payment of the full fee and will not be entitled to any refund. We reserve the right to accept or reject D Payment methods (Delegate fee(s) strictly payable in advance) delegates at our own discretion. Please select one of the following payment methods: Data protection ρ Credit card (tick as appropriate): Economist Conferences is a part of The ρ American Express ρ Mastercard ρ Visa Economist Group. We would like to keep Number: Expiry date: you informed of Economist Group products and occasionally to allow other ρ Please invoice us reputable companies to contact you. ρ Bank Transfer: payable to Bank Austria Creditanstalt Economist Conferences and its suppliers Account no: 52949 000 935 process customer data for the purposes Sort code: 12000 of customer analysis and product IBAN:AT581200052949000935 development. Economist Conferences BIC: BKAUATWW and The Economist Group operate from Please quote reference EM1008 and invoice number offices world-wide. Steps have been taken to ensure that consistently high E Confirmation standards of data protection are used in our regional offices. I/we confirm that I/we: a) have read and accepted Economist Conferences' substitution/cancellation policy (see I do not wish to receive further box to right) communications from: b) am/are authorised to sign this document on behalf of the above company. ρ Economist Conferences ρ Economist Conferences via e-mail Signature: Date: ρ Economist Group companies ρ External companies.

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