fund forum latin america 2009
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P R I O R I T Y B O O K I N G F O R MTo: Fund Forum Latin America 2009 AdministratorFax: +44 (0) 20 7017 7807Alternatively, please return this form to: FundForum Latin America, ICBI, 8th Floor, 29Bressenden Place, London SW1E 5DR, UK, Tel: +44 (0) 20 7017 7200 Email: [email protected]: www.icbi-fundforumlatam.comInscreva-se agora 1.Telefone: +55 11 30176888; 2. Enviar para: Rua Bela Cintra 967 - 11º and. - cj. 111 São Paulo - SP cep: 01415-000 BRAZIL 3. Fax: +55 11 30176918 4. Email:[email protected] 5. Website: www.informagroup.com.br/fundforumVenue: Caesar Business Hotel, Faria Lima, Sao Paulo, BrazilDates: 15-17 September 2009
DELEGATE 1 NAME.............................................................………………………………… …………….
JOBTITLE....……...………………...................................…….DEPT……………………………….………
DIRECT PHONE..………………………………MOBILE NUMBER…………………………………….
DIRECT FAX..………………………………………EMAIL………………………………………………By giving my email address I am giving IIR companies permission to contact me by email about future events andservices.
I REPORT TO........................................................................…………………………………………………
HIS/HER JOB TITLE................................................................………………………………………………
BOOKING CONTACT…….……………………………HIS/HER JOB TITLE............................................
DELEGATE 2 NAME.............................................................………………………………… …………….
JOBTITLE....……...………………...................................…….DEPT……………………………….………
DIRECT PHONE..………………………………MOBILE NUMBER…………………………………….
DIRECT FAX..………………………………………EMAIL………………………………………………By giving my email address I am giving IIR companies permission to contact me by email about future events andservices.
DELEGATE 3 NAME.............................................................………………………………… …………….
JOBTITLE....……...………………...................................…….DEPT……………………………….………
DIRECT PHONE..………………………………MOBILE NUMBER…………………………………….
DIRECT FAX..………………………………………EMAIL………………………………………………By giving my email address I am giving IIR companies permission to contact me by email about future events andservices.
COMPANY..…………………..................................................……………………………………………….
ADDRESS......................................................................................................................................……………
COMPANY TEL…............................................……....FAX…………………………………………………
PLEASE SELECT YOUR EARLYBIRD PACKAGE
DATES BOOK BY5th June 2009
SAVE BOOK BY10th July 2009
SAVE BOOK BY14th August 2009
SAVE
3 DAY PACKAGE:Conference + Brazil Summit 15-17 Sept
2009 $3298 $600 $3398 $500 $3598 $300
2 DAY PACKAGE:Conference only 16-17
September2009
$1999 $300 $2099 $200 $2199 $100
1 DAY PACKAGE:Brazil Summit only 15 Sept 2009
$1399 $200 $1399 $200 $1499 $100
3 MEANS OF PAYMENT- KR2213Please use this form as our request for payment. Your participation is guaranteed only when full payment has been received. Please tick one:
Please debit my: VISA AMERICAN EXPRESS EUROCARD MASTERCARD
Card number: CVV Number (3 digit security code on the reverse of card, 4 digits for AMEX )Exp Date_____________________ With the sum of $_________________________ Card holder’s name________________________ Signature_______________________________
Please send me an invoice BY BANK TRANSFER- Bank Transfer: Full details of bank transfer options will be given with your invoice on registration
Cancellations: Should you be unable to attend, a substitute is always welcome at no extra charge. A full refund, less a service charge of 10%, is given for cancellations received in writing (letter or fax) four weeks prior to the conference. A 50%refund will be sent for cancellations received two weeks prior to the conference. Regrettably, no refunds can be made for cancellations received less than two weeks prior to the conference but a substitute delegate is always welcome.Data Protection - The personal information shown on this form, and/or provided by you, will be held on a database and may be shared with other companies in the Informa Group in the UK and internationally. If you do not wish your details to beavailable to other companies in the Informa Group please contact the Database Manager at the above address, Tel +44 (0)20 7017 7077, Fax +44 (0)20 7017 7828 or email: [email protected]. Occasionally your details may be obtained from, ormade available to, external companies who wish to communicate with you offers related to your business activities. If you do not wish to receive these offers, please tick the box