Pre-Congress form

Catalina Anderson has provided the following information for payment of the Pre-Congress tour in Uruguay. Please pass along to interested parties. If you would like a copy of the form, please e-mail rsmith@griffithfarms.com or the e-mail below. The form can't be posted in the blog, but the following is the information on the form. Pre-tour Uruguay ( 8th to 11th June 2011) Double basis per person US$ 840 Twin bed One bed Single basis per person US$ 1195 Note: Bookings after 7th May cannot guarantee room at the Sheraton Hotel (other hotel arrangement will be made) PAYMENT : (Please select option) ( ) 1. Credit card information ( please print in capital letters) I authorize Congresos & Reuniones to charge to my credit card the amount of U$S (American dollars ) Name of Passanger: Cardholder: Card Number: Expiry Date: I ssuing Bank: Safety Code : (3 or 4 digits at front or back of card) E-mail: Address: Phone: ( ) Mobile ( ) Cardholder’s signature: Passport or ID Number: ( )2. Bank Draft : Bank: Banco Itaú – Account No.: 8069353 in USD – Account Holder: Gabriela Rohr Bank Address : Zabala 1463 – Montevideo – Uruguay (Main Branch) ABA 026009593 - Swift: ITAUUYMM (Please send bank deposit slip by fax) ( ) 3. Western Union: Please contact registrations@congresos-rohr.com PLS SEND THIS FORM BY FAX TO +598 2 9168902 OR SCANNED TO registrations@congresos-rohr.com