Formulario De Inscripcion
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VI International Congress for Mining, Oil, and Energy Cartagena de Indias, Colombia – 12, 13 and 14 OF MAY, 2010
REGISTRATION FORM
LAST
NAME:
FIRST
NAME:
IDENTIFICATION:
COMPANY OR
ENTITY:
NIT:
ADDRESS:
CITY:
COUNTRY:
E- MAIL:
TELEPHONE: FAX:
MOBILE:
NAME OF GUEST (S):
COST OF REGISTRATION
Col $850.000 + 16% VAT Until April 12th, 2010 US$ and € Col $ 900.000 + 16% VAT According to Exchange rate on From April 12th, 2010 day of registration
HOTEL RESERVATION Please complete a request form for each participant.
HILTON HOTEL CARTAGENA (5 STARS)
KIND OF ROOM ROOM RATES VI International Congress for Mining, Oil, and Energy Cartagena de Indias, Colombia – 12, 13 and 14 OF MAY, 2010
Central Building Single Col $402,000 + 10% VAT Double Col $457,000 + 10% VAT
DATE OF ARRIVAL:
DATE OF DEPARTURE: The above rates are per room and per night, and include a buffet breakfast. The tourism tax is not included and has a cost of approximately Col $3,114 per room, per night. Once completed, the hotel reservation can be secured with a credit card payment of the first night of your stay.
FORMA DE PAGO – COL $ VI International Congress for Mining, Oil, and Energy Cartagena de Indias, Colombia – 12, 13 and 14 OF MAY, 2010
REGISTRATION $ HOTEL $ TICKET $ TOTAL AMOUNT DUE $ BANK DEPOSIT OR TRANSFER Payment can be made at the following national bank accounts: Account Name GEMA TOURS S.A GEMA TOURS S.A Bank Name BANCO DE CREDITO DAVIVIENDA Account Number 501350037 7020154595 Send a copy of the deposit or transfer slip to the following fax number (57 1) 212 6146 or email address [email protected] CREDIT CARD PAYMENT (Please fill out authorization details) Card Number Expiration Date Visa: American Express: Master Card:
I authorize that the amount above be charged to my credit card:
PAYMENT METHOD – US$ or € REGISTRATION $ HOTEL $ TICKET $ TOTAL AMOUNT DUE $ DEPOSIT OR BANK TRANSFER
BANCO DE CREDITO Checking Account Name Gema Tours S.A. Account No. 501 35003 7, Business Collection Code 9037
BANCO DAVIVIENDA Checking Account Name Gema Tours S.A. Account No. 7020154595 Payment can be made to the following international bank account: Account Name GEMA TOURS S.A Bank Name HELM BANK ABA Code 0670111456 Account Number 1040095207 Bank Address 999 Brickell Avenue, Miami, Florida, 33131, USA Note: Please send a copy of the transfer to the following fax number (57-1) 212 6146. All additional bank charges are the responsibilty of the participant.
FLIGHT RESERVATIONS
Please fill in the following information to receive special airfare rates: VI International Congress for Mining, Oil, and Energy Cartagena de Indias, Colombia – 12, 13 and 14 OF MAY, 2010
Route: Date of Arrival: Preferred Time:
Route: Date of Arrival: Preferred Time:
GEMA TOURS S.A. CONTACT DETAILS FOR INFORMATION AND REGISTRATIONS Gema Tours S.A. (Bogotá) 346 50 25 Diana Velasquez [email protected]
Gema Tours S.A. (Cartagena) 660 24 99 Sugey Pajaro [email protected]