REGISTRATION FORM
(Please use one for each participant
)
Name:
Last Name:
Institution:
Title:
Address:
City:
State:
Country:
Zip Code:
Phone:
Fax:
E-Mail:
Accompanting persons:
Registration Fees:
(Please check applicable box)
Up to 7/30/99
After
Delegate
(Members of FIDES only)
US$ 750.00
US$ 800.00
Observer
US$ 950.00
US$ 1100.00
Spouse
US$ 300.00
US$ 350.00
Method of Payment:
(check one)
Check or bank draft enclosed
(payable to: Asociación Panameña de Aseguradores)
Credit card
AMEX
VISA
MASTER CARD
Name:
Number:
Exp. date:
* 100% reimbursements for cancelations before September 15, 1999. Registration can be transfered to another person by written instructions prior to October 15, 1999.
Hotel Reservation:
Single
Double
Westin Caesar Park (5*)
$135.00
$145.00
Miramar Inter-Continental(5*)
$155.00
$175.00
Marriot (5*)
$150.00
$150.00
Radisson Royal (5*)
$135.00
$145.00
El Panamá (5*)
$130.00
$130.00
Riande Continental (5*)
$125.00
$125.00
Plaza Paitilla (5*)
$88.00
$98.00
(Plus 10% Tax)
First Preference:
Second:
Date of Arrival:
Departure:
(Please include one night deposit plus tax whit your draft payment or credit card charge authorization, in order to guarantee reservation. Changes in your date of arrival must be made in writing at least 48 hours in advance, otherwise the hotel will cash in your depotsit on the original date.)
PAYMENT INCLUDES:
Registration Fee
US$
Accompanying person(s)
US$
Hotel deposit
US$
Total
US$
