:: Bangladesh Brand Forum - Meet Bangladesh

Registration Form

Section A

Prefix (Mr. /Ms.):

First Name:

Last Name:

Name of Business/Organization:

Industry/Sector:

Position in Organization:

Company Address:

City Code:

Post/Zip Code:

Country that you currently live in:

Country Code:

Landline No:

Mobile No:

Company Website:

Company E-mail:

Personal E-mail (optional):

Section B

Part 1: Which of the following Panel Discussions (PD) you would want to attend?

Please keep the Conference Agenda in front of you for references while filling up Section B.

Instruction:
• You can attend all / any / none of the Panel Discussions (PD) as in below.
• Please type “Y” for Yes beside the Panel Discussions (PD) to confirm that you will attend.
• Please type “N” for No beside the Panel Discussions (PD) to confirm that you will not attend.

No.	Panel Discussion Topic& Members	Time	Attendance Confirmation (Y / N)
1	Topic: Power, Energy & Infrastructure (PEI) Moderator: Ifty Islam, Founder, Managing Partner AT Capital Partners Panel Members: • Dr. Tawfiq – e – Elahi Chowdhury, Advisor to the Honorable Prime Minister, Govt of Bangladesh • Sajeeb Wazed Joy • Muhammed Aziz Khan, Chairman, Summit Group of Companies • Humayun Rashid,CEO, Energypac • Geoffrey Strong , President, Chevron • Md Nowshad Ali, Country Manager, GE International	10.45AM-11.35AM
2	Topic: Financial Institution and Investment Moderator: Ifty Islam, Founder, Managing Partner AT Capital Partners. Panel Members: • Salman F Rahman, President, Bangladesh Public Listed Companies • Deputy Governor-Bangladesh Bank (TBC). • Haseeb Ahmed, Senior Portfolio Manager, Chief Fixed Income Economist. Citadel Group	11.55AM-12.55PM
3	Topic: ICT & Business Services (ICT) Moderator: Anir Chowdhury, Policy Advisor, Access to Information, Prime Ministers Office. Panel Members: • Md. Nazrul Islam Khan, Project, Access to Information, Prime Minister’s Office • Mahboob Zaman ,MD Datasoft • Syed Faruk Ahmed, Chairman, Aamra Group of Companies • Peter Dindial, CEO, GPIT • Gurujot Singh Khalsa, President & CEO, Worldbridge Global	2.40PM-3.30PM
4	Topic: Manufacturing (MNF) Moderator: Ifty Islam, Founder, Managing Partner AT Capital Partners. Panel Members: • Dr Kazi Anis: Chief Strategy Officer, Gemcon Group • Munawar Misbah Moin, Corporate Director, Rahimafrooz Bangladesh Ltd. • Nazmul Hasan, MD Beximco Pharma. • Jalal Ahmed, Vice Chairman, Export Promotion Bureau	4.25PM-5.15PM
5	Role of Diaspora in Bangladesh Development Moderator: Nasim Ali, CEO, US Money Express Services, Inc Panel Members: • Dr. Ghulam Samdani, Management Consultant, Mickinsey & Company. • Dr. Abul Hussam, Professor, George Mason University. • Sakil Ahmed, Global Head of Electronic Market Making, CITINA. • Salman Khan Founder, Khan Academy (TBC).	5.20PM-6.10PM

Part 2: Which Company you would want to meet during the One-to-One Corporate Meeting?

Instruction:
• You can have meeting with only one of the Companies’ representatives stated in the brochure
• Please state more than one ‘Options’ in a Ranking order of Preference starting from 1-4

Ranking of Preference	Company Name
1
2
3
4