To register, please print and complete the following form and fax
it to (202) 312-1646 or mail to US-Panama Business Council, 1300
Pennsylvania Avenue, NW, Suite G-0003, Washington,
DC 20004. Alternatively
in Panama fax it to (507) 269-0534 or mail to
Consejo Empresarial Estados Unidos-Panamá, Edificio
Torre, Global Bank, Calle 50, Piso 22, Oficina 22 F,
Panamá, República de Panamá. You can also
register on-line
[To
Register on-line].
Name:
____________________________________________________
Title______________________________________________________
Company:
_________________________________________________
Address:__________________________________________________
City: _______________________State:
__________Zip:____________
Telephone:_______Fax:_______E-mail:__________________________
Check
Level of Participation: See Sponsorship
Benefits for Details
(Click for Sponsorship Levels & Benefits)
__
Platinum - $25,000 __ Gold - $10,000
__ Silver -
$5,000 __ Bronze - $2,500
__ Individual Participation
__
Single - $500
__ Couple - $750
Others
___ Individual - One Forum/Luncheon (Specify 11/18
OR 11/19) - $150
___ Individual - Two Forums/Luncheons (11/18 &
11/19) - $250
___ Individual - Friendship Awards Gala Dinner ONLY
(11/19) - $300
___ Couple - Friendship Awards Gala Dinner ONLY
(11/19) - $500
Name of other participant(s)_____________________________________
_____________________________________________________
Check
Events you WILL Attend: See
Program for Details
(Click
for Program)
Wednesday,
November 17
7:00 - 9:00 p.m.
___ Embassy Welcoming Reception (By
invitation)
Thursday,
November 18
8:00 - 9:00 a.m.
___ USPA Bi-National Board
meeting
(Board Members)
9:00 a.m. -12:00 n
___ Forum:
12:30 - 2:30 p.m.
___ Luncheon with Keynote
Speaker
7:00 - 9:00 p.m.
___ Tourism Presentation &
Reception
Friday,
November 19
8:00 - 9:00 a.m.
___ Power Breakfast (By invitation)
9:00 a.m. - 12:00 n
___ Forum:
12:30 - 2:30 p.m.
___ Business Luncheon with Keynote Speaker
6:30 -10:00 p.m.
___ Friendship Awards Dinner
Method
of Payment for Participation
___
Please charge my credit card: American Express /
Visa / Mastercard
(circle
one)
Credit Card #_______________________________Exp.
Date: _______
Signature:__________________________________________________
___
Check is mailed made payable to U.S.-Panama Business
Council in the
amount of $
______
