Congreso Mundial de Derecho Informático

Registration Form
Name:
Last Name:
Nacionality:
Date born:	//
Gender:	MaleFemale
Institution:
Department area:
Position:

Office Information
Address
phone:
Fax:

Home Information
Address
Phone:
E-mail Address:
Celullar:
Fax:

Classification	Quota
professionals	US$200.00
alfaredy's members	US$150.00
students	US$125.00

More Information
Country:
Arrival date :	//
Exit date:	//
Air line :
Fly number:
Amount of people who travel with you:

In order to formalize the inscription it is necessary to make the payment by means of banking transference to FUNGLODE to the account No. 711-379727, Popular Bank of Dominican Republic, or by means of special shipment check certified to the following address: Capitan Eugenio de Marchena 26 Street, La Esperilla, Santo Domingo, Dominican Republic.