Name   Last Name
Address
  
Title   Company
CITY  
State COUNTRY
P.O. BOX
TELEPHONE Fax E-Mail
SPOUSE

  REGISTRATION FEE
PRIOR TO 30/06/03
AFTER
ONE DELEGATE
US$ 600.00
US$ 700.00
TWO DELEGATES (EACH ONE)
US$ 525.00
US$ 625.00
THREE DELEGATES (EACH ONE)
US$ 450.00
US$ 550.00
FOUR OR MORE DELEGATES (EACH ONE)
US$ 400.00
US$ 500.00
SPOUSE PROGRAM
US$ 200.00
US$ 200.00

METHOD OF PAYMENT

BANK DRAFT ENCLOSED DRAFT PAYBLE TO : ASOCIACION BANCARIA / CONGRESO HEMISFERICO

WIREETRANSFERENCE:

CORRESPONSAL: THE CHASE MANHATTAN BANK, N.A. 1 THE CHASE MANHATTAN PLAZA, NEW YORK , N.Y. 10081 SWIFT BIC
CHASUS33, ABA 021000021, CUENTA #001-1-166949 A NOMBRE DE BANCAFE (PANAMA), S.A. SWIFT BIC CAFÉPAPA


AUTHORIZATION TO CHARGE TO THE FOLLOWING CREDIT CARD ACCOUNT
CREDIT CARD   AMEX VISA MASTER CARD

Name Number Exp. date

Los gastos de transferencia son por cuenta del remitente.

Reimbursements can only be made for written cancellations received prior to August 15, 2003.
Registrations can be transferred to another person by written instructions prior to August 15, 2003.

  HOTEL RESERVATION
SINGLE
DOUBLE
Hotel Riande Continental (Buffet Breakfast included in the rate)
$80.00
$80.00
Hotel Granada(Continental Breakfast included in the rate)
$50.00
$50.00
Hotel Panama Marriott (Breakfast not included in the rate)
$135.00
$135.00
  (PLUS 10% TAX))    

ARRIVAL DATE DEPARTURE DATE AIRLINE FLIGHT NUMBER

  HOTEL RESERVATION GUARANTEE
CREDIT CARD AMEX VISA MASTER CARD

Name Number Exp. date

(Please add one night deposit including tax with your draft payment, wire transfer or credit card charge authorization in case of no-show, in order to guarantee your reservation. Changes in your date of arrival must be made in writing at least 24 hours prior to your date of arrival.)

Pagos Incluídos
Monto

Cuota de Inscripción
Cuota Acompañante
Depósito de Hotel
Total

 
Send by Fax to (507) 269-5680 / 223-7787 with payment enclosed