::::: INTERNATIONAL WORLD GATHERING 2009 ::::::

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