2010 Conference Pre-Registration
Read the information carefully, then fill in the blanks:
 
General Information
Name:
Last Name:
Email:
Badge Information:
*Required
Certificate Information:
*Required
Important: If this information is changed on site, you will be charged $100.00 pesos each.
Address:
Home Office
Address (street, No.)
City State
Country Zip code
Institutional Affiliation:
 
ANUPI's Membership:
Member Non-Member
If you are Member, fill in your Membership Number:   
Expiration date:
Día Mes Año
 
I am a:
Participant Speaker
 
Conference Package:
Conference Registration only .
Conference 2010-Dorado Pacifico Hotel Package Single Room (one person)
Conference 2010-Dorado Pacifico Hotel Package Double Room (two persons)
Is your roomate participating in the Conference?
Yes No
Roomate's Name:
For the packages staying at the Dorado Pacífico Hotel:
Check in:
Day Month
Check out:
Day Month
Important: If your roomate is attending the Conference, he/she has to fill in his/her own registration form.
 
Payment Information:
Payment date:
Day Month
Total Amount:
*Required
The Payment is:
Individual Group*
* Please list the full names of participants:
Important: Your registration will appear under your name, if you need your ANUPI invoice under your institutions name, please provide the following information:
 
Name:
RFC:
Telephone number:
Full address:
Any change after your receipt has been printed will be charged $10.00 USD.
 
Send copy of your bank deposit or electronic transfer by fax (222)130 77 50, or by email asociacion@anupi.org.mx. You do not have to send anything if you paid through PayPal.
 
 
 
©ANUPI, A.C