Name_____________________________________________________________________  

Title______________________________________________________________________

Company_________________________________________________________________

Address__________________________________________________________________

City_________________     State________  Zip_________   Country________________

Telephone____________________________     Fax_____________________________

E-mail__________________________________________________________________

 

 

 

 

 

Sponsorships   (Deadline July 6th, 2005)      

___Platinum-$20,000     ___Gold-$10,000      ___Silver-$5,000     ___Bronze-$3,000     

___Gala, Table-$1,500    ___Lunch, Table-$750   

Sponsors have automatic attendance to the conference, all events and exhibit space.

 

Conference and Events

___Full registration-$600  ___Conference and 2 lunches-$450 ___Conference and Gala-$450 

___Conference only-$300 ___Conference and one lunch-$400 ___Gala Dinner only-$150 

___Field trip-$100           ___Significant other-$250

 

Method of Payment (Please complete to register and for hotel reservations)

Check in the amount of $_________. 

Please make check payable to USPA/ExpoTrans and mail it to USPA/ExpoTrans,

1300 Pennsylvania Avenue, NW, Suite G0003, Washington DC 20004

or deliver to USPA, Calle 50 Torre Global Bank, Oficina 22F, Ciudad de Panamá, Panamá.  

Credit card in the amount of $________ .    ___ Amex       ___Visa      ___Mastercard.

CC#_________________________________________________ Expiration date________  

Signature__________________________________________________________________  

 

Hotel Reservations

Caesar Park Hotel   Single occupancy - $105   Double room - $115  Please add 10% tax.

Check in ____________   Check out ___________   # of nights ____________

___Single Occupancy   ___Double Occupancy     Smoking: ___Yes   ___No    

Special requests will be accommodated if possible _______________________________

________________________________________________________________________

 

Flight Information

Arrival Date _________  Airline/Flight #________ Arrival Time _____ From____________

Departure Date _______ Airline/Flight #_______ Departure Time _____To ____________  

 

Washington Office                                         

U.S.-Panama Business Council                                             

Ronald Reagan Building & ITC                 
                             
1300 Pennsylvania Ave., NW – Suite G0003                      

Washington, DC 20004                                                       

Tel. (301) 986-8802  Fax. (301) 986-8803                         

E-mail: Panamerica@msn.com                                             

Website: www.us-panama.org                                         

Attention: Juan / Margaret Sosa                                       

Panama Office  

Consejo Empresarial EEUU-Panamá

Apartado 87-3580, Zone 7 – World Trade Center

Calle 50, Torre Global Bank, Oficina 22F

Ciudad de Panamá, República de Panamá

Tel. (507) 269-2178   Fax. (507) 269-0534

E-mail: uspa@cableonda.net

Website: www.us-panama.org

Attention: Roberto Dominguez / Enrique Sosa


PLEASE FAX REGISTRATION FORM TO

USPA-USA (301) 986-8803 OR USPA-PANAMA (507) 269-0534  

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