icaApplication
Exhibitors
Company address
Company Street/ P.O. Box Country/ Postal Code E-mail / Homepage
Manufacturer Service company

19th international trade fair for innovative electronics production, 15–18 November 2011, Phone (+49 89) 9 49-2 03 20/2 03 30, info@productronica.com, www.productronica.com

Please complete in full and send to: Messe München GmbH, Messegelände, 81823 München, Germany or fax to: (+49 89) 9 49-2 03 39

5% Early Bird Discount if you register by 30 November 2010
City
www.

Stand allocation begins: 17 January 2011 Price includes unlimited quantity of vouchers for one-day tickets (see B16)

Distributor with exclusive selling rights for Germany

Contact
Title First Name Last Name

Sales/Marketing manager

E-mail Sales/Marketing manager

Ms Mr

Phone with area code and extension

Press contact

E-mail Press contact

Fax

Official company representative (President/CEO) (only if differing from above)

E-mail contact

Member of the following trade associations

Function/Position/Department

Number and place of company registration/VAT-ID No.

Address for correspondence (only if differing from above)
Company Street/ P.O. Box Country/ Postal Code City Contact Phone, Fax
(Country + area code + number)

Ms Mr

E-mail

Due to value-added tax legislation, invoices cannot be issued to an addressee other than the exhibitor. Please note item B15 of the Special Terms of Participation (B).

Headquarters of the parent company with full address and country: ____________________________________________________________

____ ____________________________________________________________

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_____ Under which country would you like to be included in the statistics: Headquarters Branch Country: _______________________ Co-exhibitors: For registration of co-exhibitors please fill in “Application Co-exhibitors” No. of co-exhibitors: No. of