ARPEL CourseAccreditation on pipelines integrity management

Module II: internal corrosionJuly 2-7, 2012 – Rio de Janeiro, Brazil

REGISTRATION FORMONLY ADVANCED REGISTRATIONS WILL BE ACCEPTED – THERE WILL NOT BE ON-SITE REGISTRATION

DEADLINE FOR REGISTRATIONS: JUNE 22, 2012

PLEASE USE CAPITAL LETTERS (*Mandatory fields)

REGISTRATION FEES (INDICATE YOR CATEGORY)

ARPEL Members………………………………………………………………………. 3,500 USD (American dollars)

CTDUT Members………………………………………………………………………. 4,000 USD (American dollars)

Other Companies and Institutions……..………………………………..….. 4,500 USD (American dollars)

PERSONAL INFORMATION

* First Name:       * Last Name:      

* Position:       * Company / Institution:       * Fiscal Number:      * Address:       * City:       * Country:      * Phone: (     )       * Fax: (     )       Mobile:      * E-mail address:      

PAYMENT METHOD (INDICATE YOUR CATEGORY)If you pay by wire transfer please complete and send this form by e-mail inscripciones@arpel.org.uy or by fax to (598) 2410 92 07 before June 22, 2012

WIRE TRANSFER To perform a wire transfer, please contact Mr. Fernando Uberti, via e-mail: admin@arpel.org.uy or by phone: +(598) 2410-6993 Exts. 125 or 141.

NOTE: Wire transfer shall be made in US dollars only. Wire transfer expenses, retentions or taxes should be added to the payer’s account transfer. Once the wire transfer is made, please send a copy of the receipt by e-mail to admin@arpel.org.uy or by fax to +(598) 2410 9207

If you pay by credit card please complete, print and sign this form and send it back by fax to (598) 2410 92 07 before June 22, 2012. Should you prefer to inform credit card details by phone, please call to +(598) 2410-6993 extensions 141 or 125. For your security do not send this information by e-mail

CREDIT CARD AmountUSD      

* Card number:      

* Security code:     

* Expiration date:     

* Cardholder name (as indicated in the credit card):     

* Cardholder’s signature:

YOUR REGISTRATION WILL BE CONFIRMED ONCE RECEIVED THE COPY OF SWIFT TRANSFER OR THE AUTHORIZATION OF YOUR CREDIT CARD

THE REGISTRATION INCLUDES: Full participation to Seminar, folders, lunches, coffee breaks, hard copy of the Reference Manual and transportation from and to CTDUT facilities.

Cancellation PolicyCancellations received in writing to the ARPEL Secretariat inscripciones@arpel.org.uy before June 22, 2012 will be refunded deducting 30% of administrative fees. These will be refunded once finished the Seminar. After deadline no reimbursement of registration will be accepted, but transfers (participant change) will be considered at a fee of USD 20 each one to be paid until July 2, 2012.

Javier de Viana 1018, 11200 Montevideo, Uruguay Tel.: (598) 2410-6993; Fax: (598) 2410-9207 info@arpel.org.uy; www.arpel.org