EXHIBIT

Name

*

Company

Country

Phone

*

Email

*

verify email

*

Web site

Please answer the following questions:

Attended 2012 Iraq Energy EXPO

Yes No

Interested in sponsorship

Yes No

Are you doing business in Iraq now

Yes No

Do you need special help with accommodations

Yes No

Do you need special help with transportation

Yes No

Do you need special help with visa

Yes No

Do you need special help with travel

Yes No

Do you need special help with meeting MoO officials

Yes No

Approximate size booth would like to have in square meters