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Formulario de Inscripción
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)


REGISTRATION FEES (Includes Social Activities)
Delegates* N° Persons (*) Early birds
(November 30th 2008)
2nd Daedline
(Since December 1th 2008)
Delegates U$S 280 U$S 330
Siblings (16 to 20 years old) U$S 120 U$S 120


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


SOCIAL ACTIVITIES (Only if you are not registered for the Congress)
Closing Dinner - May 8th: U$S 98
Argentinean Farm Tour - May 9th: U$S 110


EXTRA INFORMATION(If yes please conctact the General Secratariat by e-mail)
Photos & Mementos
Banners/Quilts
Others


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 fax this form to: 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

 
 
 
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  Host
Institutions
   
   
Colaborates
   
The compassionate friends International gathering
The compassionate friends will gather again for the 2009, in this opportunity Argentina and Buenos Aires, as the venue of The Compassionate Friends,  5th International Gathering, will give us the opportunity...
 
  Covitour EVT Legajo: 8969 - Freire 1512 - Capital Federal (C1426AWF) República Argentina
Phone: (54-11) 4555-0420 / Fax: (54-11) 4554-0380 | worldgathering2009@covitour.com
   
See..