Please complete this form to register:

Platts Global Energy Outlook Forum

November 29, 2012

First Name

Last Name

Company

Email Address

Job Title

Business Phone

Mobile Phone

City

State (required for USA)

Province (required for Canada)

Country

Check all that apply:

Print or on-line publication

Television or Radio outlet

I would like to bring a camera crew

I would like an interview with Platts editorial board

I would like an interview with the attending executive of (insert company name)