12th ABLA CONVENTION 2012

Santo Domingo, DN; Dominican Republic

Leaders Convention

Librarians Convention

ELT Convention

International Registration Form

First Name:

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Last Name:

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Institution:

Centro Cultural Colombo Americano, Cali

Position:

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Country:

Chile

City:

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Postal Code:

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Mailing address:

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Telephone:

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Fax:

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E-mail:

pablovv2008@hotmail.es

Date:

Fri, 29 Jun 2012

How your name will appear on the certificate?

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Payment information:
Three-day Librarians' Convention (November 12th - 14th, 2012)

Total:
US $225.00

Payment method:
VISA

MASTER CARD

Credit Card Number:

Cardholder's name:

Expiration date:

Security code:

AMERICAN EXPRESS

(Last three digits on back of card)

* Early Registration: If you register before June 30th, 2012, you will receive a US$20.00 discount.
* Regular Registration: Registrations submitted between July 1st and September 30th, 2012.
* Late Registration: If your register after October 1st, you will be charged an additional fee of US $25.00.
+ Additional 20% discount if three or more people from the same BNC register before June 30th, 2012.

City:

Signature:

Date:

Fill up this form and send it to this Fax number 8092552600

Av. Abraham Lincoln #21, Santo Domingo, Repblica Dominicana,

Tel. 809-535-0665, ext. 2202, 2102