Registration Form

Please complete this form (type or fill out in BLOCK letters) and return with payment to: CONGREX do Brasil

Av. Presidente Wilson, 164 / 9º andar
Centro - Rio de Janeiro - RJ
20030-021 Brazil
Phone: +55 21 220-3386 Fax: +55 21 240-8195
Email: congrex@ax.apc.org

REGISTRATION INFORMATION

Family Name First Name
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Title
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Instituition/Organization/Company
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Mailing Address
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Phone

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Fax

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E-mail
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ACCOMPANYING PERSON

(    )Mr. (    )Mrs. (    )Miss
Family Name First Name
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REGISTRATION FEES

On or before July 1, 1997
US$/pax
Nº of Persons
Code
Total US$
Scientific Participants
450
001
Students
225
002
Accompanying Persons
180
003
After

July 1, 1997
US$/pax
Nº of Persons
Code
Total US$
Scientific Participants
550
004
Students
275
005
Accompanying Persons
250
006

ACCOMMODATION

Congress rates
Hotel
Stars
Sgl

US$
Dbl

US$
Inter-Continental
130,00
140,00
Copacabana Praia
67,00
94,00
Debret
52,00
65,00

Inter-Continental

Daily rates are per room.

Taxes to be added to the daily rates: 10% of service tax, 5% of ISS.

Breakfast is not included and will have to be paid directly at the hotel.

Additional Conditions:

Check-in ___________ Check-out date _________ (_____ nights)

Hotel accommodation can only be guaranteed for reservations received up to June 15, 1997.

Date____________Signature_____________________________________

ACCOMPANYING PERSON TOURS (enclose full payment)
Tour
Price per Person
Nº of Persons
Date and am/pm
Total
Corcovado/Beaches
US$ 36,00
Historical City Tour
US$ 25,00
Petrópolis
US$ 25,00
Tropical Islands Tours
US$ 46,00
Rio by night
US$ 66,00

PRE AND POST TOURS (enclose full payment)
Tour
Price per Person (sharing room)
Nº of Persons
Date and am/pm
Total
Salvador/Recife
US$ 470,00
Manaus
US$ 470,00
Brasilia
US$ 150,00
Pantanal
US$ 840,00
Foz do Iguaçu
US$ 190,00

METHOD OF PAYMENT

Regist. fee US$________

Tours US$________

Hotel US$________

Total US$________

(   ) By bank check: Check payable in New York, made out to ICAME'97, and sent to the Conference Secretariat with the registration form.

(   ) Please charge my credit card: (   ) MASTERCARD (   ) VISA

Credit Card Number: _____________________________________________

Expiration Date:_________________________________________________

Date: ____________Signature:_____________________________________

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