The Eurasia Center & the Eurasian Business Coalition

Registration Form DOING BUSINESS WITH BRICS CONFERENCE The Eurasia Center & The Eurasian Business Coalition

Principal Contact: ______

Position: ______

Firm/Organization: ______

Address: ______

City/State/Zip Code: ______

Tel/Fax: ______

Email: ______(Early Registration Discount) Conference Participant: $300 (Only $175 if you Register before May 18th) ___ 100% Tax-Deductible (Conference Participant fee includes Lunch & Evening Reception and transportation between venues)

Only Special Russian Embassy Evening Reception ($50): ______50% Tax-Deductible

Participant’s Name: ______

*Paid by Credit Card (X): ___VISA ___MasterCard ___AMEX ___Discover (No Debit Cards)

Card in Name of: ______

Credit Card Number: ______

Address of Card Holder (must match card used): ______

Expiration Date: ______*(by check) ______Questions Call: 202-494-0773

Names of other Guests (if any) ______

This Form may be emailed to: [email protected]

Make check payable to: The Eurasia Center Registrations can be faxed to: 202-237-1452 or mailed to the: The Eurasia Center/EBC Doing Business with the BRICS Conference 4927 Massachusetts Avenue, NW Washington, DC 20016 USA

Please contact Michael Cooper, at The Eurasia Center (202) 494-0773 [email protected]