Registration

1. PERSONAL DATA
       
Title :
First Name:
Last Name:
Company:
Position:
Address:
District: City:
State: Country:
Telephone: Zip Code:
  (Country Code)+(City Code)+(Telephone)
Email:
 

2. INVOICE INFORMATION (If needed)
       
BussinesName: RFC:
Address:
City: State:
Country: Zip Code:

CATEGORY BEFORE
AUG 6th, 2014
ON - SITE
Alasbim Members $ 600.00 USD $ 750.00 USD
WFNMB Member Society $ 700.00 USD $ 875.00 USD
NON Member $ 800.00 USD $ 1,000.00 USD
Resident $ 200.00 USD $ 250.00 USD
Technologist $ 200.00 USD $ 250.00 USD
     
Accompanying People $ 100.00 USD $ 125.00 USD
*Accompanying Name:
  *Includes welcome cocktail, exhibition & closing dinner

CLOSING DINNER FOR ALL ATTENDEES
$ 100.00 USD No, thanks.

 

3. FORM OF PAYMENT
       
Name on Card:
Card Issuer: Card Number:
Security Code: Expiration Date: month year
     
  Visa and M.C. a 3 digit number found in the back of the card
American Express a 4 digit number found in the center right of your card