Registration Form
 
Full Name: 
  
Name for ID tag: 
  
University/Agency:
  
Phone:
  
FAX:
  
email:
  
 
 
(      ) Yes, I wish to attend the Pre-Conference 
(      ) Yes, I wish to attend the Post Conference 
(      ) Yes, I wish to visit Carajás Mining Complex (22 and 23 August) 
(      ) Yes, I wish to visit EMBRAER Aircraft Industry (after Post Conference) 
(      ) Yes, I wish to visit ITAIPU Hydroelectrical Complex (after Post Conference) 
(      ) Yes, I wish to visit PETROBRÁS offshore deep-sea platform (after Post Conference) 
(      ) Yes, I wish to visit Nuclear Power Plant Angra II
For more information please visit our home page: http://www.ctc.puc-rio.br/icee-98
 
Registration Fee for Congressists (including pre and post conference registration and lunches during conference)
Advance (      )
After (      )
 ABENGE's 
membership (   )		 Students (   )
By Friday, July  17,1998
July 17, 1998 or at Conference
number: ..........
US$250.00
US$300.00
 FREE for the first hundred US$ 50.00 without lanches 
Registration Fee for Accompanying Persons - (    ) US$80.00
Name:..........................................................................

City Tour including Dinner on Wednesday - 19th August - (    ) US$40.00 per person
 
Total to be billed to account:  US$                 .
 
Form of Payment
 
1. (     )  Nominal Check to FACULDADES CATÓLICAS  
Please send by mail. Only Brazilian Bank Check will be accepted
2. (     )  Deposit in Bank Account. FACULDADES CATÓLICAS 
Banco Itaú - Ag. 1108, c.c.: 22195-1 
Please send Bank receipt by fax to Blumar (021) 511 3739
3. (     ) Payment Order. Please go to any bank in your city and make a Payment Order to: FACULDADES CATÓLICAS 
Banco Itaú - Ag. 1108, c.c.: 22195-1 
Swift code: ITAUBRSPRJO 
In this case, you should add $15 to the fee registration value, to cover costs of payment order. 
Please send Bank receipt by fax to Blumar (021) 511 3739
4. CREDIT CARD
(      ) American Express (     ) Visa (     ) Diners (     ) Master Card / Others
Name of Card Holder: 
.
Credit Card Number: 
.
Expiration Date:
.
Total Amount:
.
Passport number:
Please send a copy of the card

This authorization is for the payment of Conference fee to Blumar under the name of:
 

 
Card Holder Signature
Date

 
Registration will be made only after payment
Please fill out and send to Blumar by fax or mail:
Rua Visconde de Pirajá, 550 ss 108 – Ipanema
22410-002 - Rio de Janeiro - RJ Brazil
Phone.: (+55) (21) 511 3636 - 512 3153
Fax (+55) (21) 511 3739
E-mail: eventos@blumar.com.br
If you wish to register more than one participant, please feel free to use as many copies of this form as necessary