Personal Identification
Full Name:  

Gender: (   ) Female      (  ) Male 

Institution/Company 									
	
Passport number 								 Issued date :

City: 						State:              		             Country:

Phone :  				                                       Mobile: (    ) 

E-mail : 

 INFORMATION ABOUT YOUR FLIGHT 

Arrival in Brazil 
•	Date of arrival:____/_____ 
•	Air Company: ___________ 
•	Flight Number:___________ 
•	ArrivalTime:_____________	

Airport of Arrival 
(   ) São Paulo International  - GRU                     (   ) Campinas – Viracopos (VCP)
(   ) Other ___________________________________________________________

•	Are you coming with accompanying person (not participant of the conference)? 
             Yes (   )    Name(s): _____________________________________	No (    )
				   _____________________________________

Departure
•	Date of Departure:____/_____ 
•	Air Company: ___________ 
•	Flight Number:___________ 
•	Departure time:_____________
•	Airport of departure:______________________	

Please send a scanned copy of this form to hemipteran@caprioliturismo.com.br 
or by fax to + 55 (19) 3232-7888

 Choose your Hotel Preference 

Hotel: 
1º Option Hotel - ________________________________________
2º Option Hotel - ________________________________________

Check-in Date:_____/____    Check-out Date: _____/____ 

Type of room:  Single (    ) 	  Double  (   )		Twin bed (   )   	Triple(   )    

Name of the persons sharing the same room: ( please inform the age if you have any kids) ____________________________________________________________________________________________________________________________________________________________________________________

Guarantee of Payment
I´m aware about the conditions of cancelation policy and that my reservation is only confirmed if I send the credit card guarantee - No charge will be done in the credit card unless the reservation has a no-show. 
The payment of the hotel will be done at your arrival at the hotel 

Need more information? 

_________________________________________________________________________________________

_________________________________________________________________________________________

CREDIT CARD GUARANTEE DEBIT AUTHORIZATION
I Authorize the hotel of my preference to charge in my credit card the Guarantee of no show and payment of room rates plus taxes regarding my reservation for the Hemipteran Plant Interactions Symposium –
 (July  10-14, 2011) 

Name ____________________________________________________
(Same printed on the card)

Passport number 						     Issued date :

Type of credit card: 

Number: 

Valid through ___/___ 

Security code  _____

____________________      _______________________
City and Date				     Signature 

Please return a scanned copy by email hemipteran@caprioliturismo.com.br or by fax to: + 55 (19) 3232-7888