IV LATIN AMERICAN CONFERENCE ON BIOBANKS
REGISTRATION FORM Please use block capitals
SURNAME NAMES
ADDRESS CITY
ZIP/ POSTAL CODE PROVINCE/STATE COUNTRY
TELEPHONE FAX CELLULAR PHONE
PROFESSIÓN
INSTITUTION / ORGANIZATION ADDRESS/COUNTRY
REGISTRATION DATA
Registration deadline: 08/29/08 September 4 September 5 and 6 September 4, 5 and 6
MEMBERS $100 $150 $200
NON-MEMBERS $200 $250 $340- U$S120
Discount deadline: 07/20/08 September 4 September 5 and 6 September 4, 5 and 6
MEMBERS $ 80 $120 $160
NON-MEMBERS $160 $200 $280- U$S 100
METHOD OF PAYMENT MEMBER YES ( ) NO ( )
Cash ð Check payable to CEMIC ð Credit cards ð
AMOUNT
CHECK Nº BANK
CREDIT CARDS
I hereby authorize to debit from my credit card the amount stated below
American Express ð VISA ð MASTER CARD ð
Card Number Security Code Month Year Amount
Expiration Date
Cardholder full name Cardholder signature
CHECKS
The registration form must be sent by mail or submitted personally to CEMIC. The check payable to CEMIC (in Argentine pesos) must be issued by an Argentine bank. In case of wire transfer and/or deposit (in US dollars), the operation must be done in a US bank.
The wire transfer or deposit confirmation must be sent by fax, e-mail or private courier. Otherwise, due receipt will not be issued and the registration will not be considered.
The organizing committee is not responsible for lost checks sent by ordinary mail. Private courier is strongly recommended.
Transfer data (US dollars):
J. P. MORGAN CHASE 270 Park Ave – 43rd floor NY – NY10017
Bank Account: CEMIC / ABA (or routing #): 021 000 021 / checking account: 949-1-425865
CREDIT CARD
The registration form must be sent by fax, e-mail to ANA FINOCHIETTO COMUNICACIONES () / (5411 4733-9270), or mail, or it may be submitted personally to CEMIC. The credit card data must be provided (credit card name, number, security code, expiration date, amount and signature).
CASH PAYMENT
Cash payments may be in Argentine pesos or in American dollars (in an amount equivalent to Argentine pesos). Cash payments must be done at CEMIC.
Time:10 am – 01 pm / 03 pm – 05 pm
Places:
CEMIC, C. Saavedra (Cashier) Galván 4102 – CABA (C1431FWO); phone (5411) 4546-8241/8244/8254
CEMIC, Central (Cashier) Av. Las Heras 2939 – CABA (C1425ASG); phone (5411) 4809-1922/23
REGISTRATION CANCELLATION:
Cancellation requests must be made in writing to ANA FINOCHIETTO COMUNICACIONES. Those received prior to 20 July 2008 will be fully refunded, except for $50 (Argentine pesos) for administrative costs. Cancellation requests received between July 20 and August 29 will receive a 50% refund of the registration, except for $50 (Argentine pesos) for administrative costs. No refunds will be made after that date.
Secretariat ANA FINOCHIETTO COMUNICACIONES. (5411) 4733-9270 /