II CEMLA-SEACEN Conference“The Role of Central Banks in Macroeconomic and Financial Stability: The

Challenges in an Uncertain and Volatile World”

Punta del Este, UruguayNovember 15 and 16, 2012

REGISTRATION FORM

Please return your completed form to conferencia ce mlaseacen2012@bcu.gub.uy or fax: +598 2902 6578) no later than October 26, 2012. Thank you for your cooperation.

Personal particulars:

Mr./Mrs./Ms./Dr. Last Name: First Name:

Title/Department:

Institution:

Tel: Fax: Email:

Address:

Name to appear on Name Tag:

Assistant’s Name: Tel: Email:

Accompanied by Family Members Name: Relationship:

I will attend the lunch on November 15 □ Yes □ No

I will attend the dinner on November 15 □ Yes □ No □ Accompanied

I will attend the lunch on November 16 □ Yes □ No □ Accompanied

Dietary Restrictions: □ None □ Vegetarian □ Other: (specify) Please indicate details of your flights below

I will arrive at: □ Carrasco Airport in Montevideo* □ Laguna del Sauce Airport in Punta del Este:

Arrival Date: Flight No: Time:

Please insert an electronic photo

Departure Date: Flight No: Time:

* There will be shuttles to transport participants from Carrasco Airport in Montevideo and Laguna del Sauce to the Conrad Hotel in Punta del Este. Please indicate if you will take the shuttle.

□ Yes, I will take the shuttle Date:………….

HOTEL INFORMATION

Hotel Accommodation: Please ( your choice of accommodation

Conrad Hotel US$ 205 Single DoubleSunsetbeach-hotel US$ 116/128 Single Double

(Uruguayan citizens + 10% Tax)

CREDIT CARD INFORMATIONThe credit card will be used to guarantee your arrival at the hotel

CREDIT CARDS: /choose one): AMEX □ VISA □ MASTER □ DINNERS □

CREDIT CARD NUMBER: …………………………………………

SEC. COD.: ……..

EXPIRATION DATE: ……………………………………………

ISSUING BANK: …………………………………………………………

PRINT CARD HOLDER’S NAME: …………………………………

CARD HOLDER’S SIGNATURE: …………………………………………………………………..