REGISTRATION INSTRUCTIONS

1.  REGISTRATION INFORMATION:

Salutation:       £    Mr.             £    Mrs.                £    Ms.                  £     Dr.

Last Name:                                                         First Name:

 

 

Exact  Title:

 

Company / /Organization:

 

Address:

 

City:                                            State:                      Country:

 

 

 

Zip/ Postal Code:                    Area / Country Code:       Telephone #:

 

 

 

Fax Number:                                        E-Mail Address:

 

 

E-Mail Address Must Be Provided.  If You Do Not Have One, Please Indicate. ________________________________________________________________________

2.  REGISTRATION CATEGORY:

Registration Includes:  Full access to forum events (coffee breaks, lunch, and cocktail), all sessions, and transport to/from Las Minas Terminal in Colon, Panama.

 

Ÿ Option 1: $300      Ÿ Option 2: $200                                             Ÿ Option 3: $125

Events of 3 days          Thursday Forum, lunch, & Friendship Dinner   Friendship Dinner Only

 

Ÿ   Please check here if you WILL be participating on a morning Field Trip to be   announced.

   (CAPACITY LIMITED. Reserved only for international attendees and Option 1.).

____________________________________________________________________________

3.  PAYMENT INSTRUCTIONS: (Please Check Only One)

Credit Card

£  American Express      £  Visa       £  MasterCard

Credit Card Number:

 

Cardholder Name:

 

Expiration Date:

Signature:

 

£  Check or Money Orders Enclosed Payable to U.S.-Panama Business Council / Consejo Empresarial EEUU-Panamá).  All Checks should be in U.S. Dollars and Drawn on / payable through a U.S. Bank.  SORRY, WE CANNOT ACCEPT CHECKS PAYABLE THROUGH A FOREIGN BANK.

For Wire Transfer Information, please contact:

U.S.-Panama Business Council at (713) 426-0554

REGISTRATION WILL NOT BE PROCESSED WITHOUT RECEIVING PAYMENT .

FAX
Credit Card Payment Only
Send your completed form to:
Fax (713) 426-0554 in the United States
Fax (507) 269-0534 in Panama

MAIL
USA: 5353 Memorial Drive #2041, Houston, TX 77007
Panama: Calle Ricardo Arias, Campo Alegre Edificio Proconsa II, Oficina 9D, Panama City

E-MAIL:
USA: Panamerica@msn.com
Panama: Enriquesosa79@cableonda.com

FOR FAX AND MAIL REGISTRANTS, PLEASE ALLOW 72 HOURS FROM DATE OF RECEIPT FOR REGISTRATION CONFIRMATION.

HOTEL ACCOMMODATIONS

Miramar InterContinental

£   NEEDS A ROOM         £  DOES NOT NEED

£  Single                        £  DOUBLE

£  SMOKING                    £  NON-SMOKING

£  KING SIZE                   £  DOUBLE

Requirements________________________

Check in date:_________________________

Check out date:________________________

PLEASE PROVIDE A CREDIT CARD NUMBER IN THE RIGHT SECTION OF THE FORM TO RESERVE YOUR ROOM AT THE MIRAMAR INTERCONTINENTAL AT :

£  $200  A NIGHT, SINGLE OCCUPANCY OR         £  $225 A NIGHT,  DOUBLE OCCUPANCY

(Continental breakfast included)

IMPORTANT INFORMATION:
Space for this forum is limited.
CCAA does not guarantee registration after full capacity is reached.

 

CANCELLATION AND REFUND POLICY:
There will be NO REFUNDS of registration
In case of Cancellation, registration fees will be credited towards your participation in other
CCAA or USPA events

For Updated Forum Information
Please Visit our Website: www.us-panama.org  

(Covering Letter)
 (Program)
(Sponsorship Opportunities)
(Registration Instruct. & Form)
(Sponsor Registration Form)