Please complete this form, print and fax.
Thank you.
DELEGATE INFORMATION
Títle*: Mr. Miss Dr. Prof. Other:
Last Name*: Name*:
Address*: City*:
Zip Code*: State*: Country*:
Phone (Country C./Area C/Number)*: Fax (Country C./Area C./Number)*:
E-mail*: Passport*:
Birth Date*: / / (yyyy)


ACcOMPAnying delegate
Last Name: Name:
Passport: Birth Date: / / (yyyy)
Last Name: Name:
Passport: Birth Date: / / (yyyy)
Last Name: Name:
Passport: Birth Date: / / (yyyy)


Housing
Hotel Panamericano Buenos Aires 5* (Official Hotel)
Room Type: Regency U$S 225.- Junior Suite U$S 295.-
Broadway Suites 4*
Room Type: Junior U$S 194.- Superior U$S 224.-
N° Persons:
Check in: / /2009 Check out: / /2009
Smokers Not smokers
Special requirements:


PRE/POST (Land services)
Tour Hotel Single U$S Double U$S N° Persons Día
Iguazú Sheraton Iguazú Resort & Spa 5* 850 460 / /2009
Hotel Panoramic 5* 555 310
Hotel Esturión 4* 375 220
Noroeste Argentino Sheranton Salta Hotel 5* 810 552 / /2009
Hotel Casa Real 4* 640 810
Hotel Posada del Marqués 3* Sup 547 407
Calafate Xelena Deluxe Suites Hotel 4* 599 365 / /2009
Mirador del Lago Hotel 4* 460 295
Edenia Hotel Punta Soberana 3* 430 280
Contracting 2 or more excursions obtains 10 % of discount.


BUENOS AIRES TOURS (If yes please conctact by e-mail)
Tour N° persons Date
City Tour / /2009
Tigre - Delta - Complete day / /2009
Colonia - Uruguay - Complete day / /2009


TRANSFERS IN / OUT (U$S 180.- one person and U$S 100.- 2 persons)
Arrive: Airport / Hotel Yes No
N° Persons: Date of Arrive: / /2009
Hour: Flight N°:
Exit: Hotel / Airport Yes No
N° Persons: Date of Exit: / /2009
Hour: Flight N°:
*Please conctact by e-mail for more persons.


PAYMENT INFORMATION
Credit Card*: Mastercard Visa American Express
Number*: Expiration Date*: //
Cardholder Name*: Security Code*(**):
Issuing Bank: Billing Address:
ID Number: Birth Date: // (yyyy)
Date: Cardholder Signature:


* Obligatory information
(**)VISA & MASTERCARD: Numbers (3) which appear on the back of the card, next to the last four numbers of your card.
(**)AMERICAN EXPRESS: Numbers (4) printed above your card number to the right.


BANK TRANSFER
Banco de la Nación Argentina
777 Brickell Ave* suite 802
MIAMI, FL33131
Cuenta: 0043224205002
ABA: 066010678
SWIFT: NACNUS3M
Beneficiario: COVITOUR CONGRESOS S.A.
IMPORTANT: FREE OF CHARGE FOR THE BENEFICIARY
I authorize Covitour Congresos S.A. to debit from my credit card the total amount mentioned above.
Signature: Name:

Please send this form: COVITOUR CONGRESOS SA
Cap. Gral. Ramón Freire 1512 - C1426AWF - Buenos Aires - Argentina
Phone: +54-11 4555-0420 - Fax: +54-11 4554-0308
E-mail: worldgathering2009@covitour.com