Federation of Asia-Pacific Womens Association 20th Convention

Empowering Asia-Pacific Women Through Knowledge and Opportunities

October 25-28, 2012 Aurora Resort & Spa, Island of Guam, USA

REGISTRATION FOR CONVENTION

Please TYPE or PRINT Clearly in CAPITAL LETTERS Name: Salutation: Mr. Mrs. Ms. Dr. Organization: Address: Country: E-mail: Telephone: Accompanying persons: Date of Arrival: Date of Departure: SPECIAL NEEDS: Workshop Preference Time: Time: (Please choose one) Conference Fee Flight No: Flight No: US$ 260.00/ per person , Early Bird Mobile: Fax: Prof. Position or/and Title:

Vegetarian Meals Wheel Chair Others:_________________________________

Women in the Modern World Women and Sustainability Womens Health Issues Women and Education

After 31 August 2012 - $280.00/person Fee includes: Convention bag, All Sessions, Opening & Closing Ceremony, 3 lunches & 4 dinners. Total persons Total fee

Mode of Payment by Money/Telegraphic Transfer or Credit card (Please fill out separate form attach):

Bank Account Name: Guam Council of Womens Club - FAWA 2012 Bank Account No: 0121-039684 Name of Bank: Bank of Guam, Upper Tumon Branch Bank Address: PO Box BW Hagatna, GU 96932 Routing Number: 121405115 Swift Code: GMBKGUGU E-mail or Fax your registration with your proof of payment To: ntan@moylans.net or 671-477-1837 Attn: Nancy Tan

Comments, Questions or Queries, please contact:

E-mail:ntan@moylans.net Tel No.:+671-477-7500 Ext. 125 Fax:+671-477-1837 Mobile No. :+671-482-6382 Attn: Nancy A. Tan

We will send a confirmation upon receipt of the completed form and registration fee

Registration Deadline: August 31, 2012

Credit Card Authorization Form

Credit Card: VISA Card No : MasterCard Only Expiry Date: / (MM/YY) Security Code: (Located @ back of credit card) Amount: ___________________ Date:

Card Holder Name (printed): Billing Address:_______________________________________ Authorized Signature:

By signature above, I hereby authorize the Guam Council of Womens Club FAWA to charge the above specified amount to my credit card. NOTE: Please scan and return together with registration via email to Nancy Tan at ntan@moylans.net.