============== Beginning of Payment Form (cut here) ============== PAYMENT FORM FOR REGISTRATION, TRANSPORTATION AND MT-DIW5 TO BE RETURNED BEFORE 15TH MAY 2000 TO: Meta Marketing e Eventos Ltda. c/o 15TH WORKSHOP ON ELECTROMAGNETIC INDUCTION IN THE EARTH Av. Nilo Pecanha, 50 - grupo 1610 20044-900, Rio de Janeiro Brazil Tel: +55-21-2202097 or +55-21-5240676 Fax: +55-21-2202305 E-mail: meta@domain.com.br Surname:______________________ First Name:__________________________ Mr/Ms:____ Organization:__________________________________________________________________ ___________________________________________________________________ Address:_______________________________________________________________________ City:____________________ Postal Code:__________________ Country:______________ Phone:_________________________________________________________________________ Fax: _________________________________________________________________________ E-mail:________________________________________________________________________ Accompanying Person(s):1._______________________ 2:____________________________ TYPE OF PAYMENT: Credit Card:____________ Check:_________ (VISA, MASTER or DINERS) ------------------------------------------------------- | TOTAL REGISTRATION: ___________________ US Dollar | ------------------------------------------------------- | TOTAL TRANSPORTATION: ___________________ US Dollar | ------------------------------------------------------- | TOTAL MT-DIW5: ___________________ US Dollar | ======================================================= | GRAND TOTAL: ___________________ US Dollar | ======================================================= Payment can be made by one of the followings: 1. Credit Card (VISA, MASTER or DINERS only). ------------------------------------------------------------------------------- | | | Credit Card:_________ Number:____________________________ Exp.Date:________ | | | | Issuing Institution:_______________________________________________________ | | | | Name as shown in credit card:______________________________________________ | | | | Signature of card holder:__________________________________________________ | | | | Total Amount Paid:_______________________________________________ US Dollar | | | ------------------------------------------------------------------------------- CAUTION: INFORMATION OF YOUR CREDIT CARD SHOULD NOT BE SENT BY E-MAIL NOR BY THE WORLD WIDE WEB FOR THE SAKE OF SECURITY. IT WILL BE ACCEPTED ONLY BY POSTAL MAIL OR FAX TO: Meta Marketing e Eventos Ltda. c/o 15TH WORKSHOP ON ELECTROMAGNETIC INDUCTION IN THE EARTH Av. Nilo Pecanha, 50 - grupo 1610 20044-900, Rio de Janeiro Brazil Tel: +55-21-2202097 or +55-21-5240676 Fax: +55-21-2202305 E-mail: meta@domain.com.br 2. Corporate or personal checks in US Dollar MUST BE PAYABLE TO META MARKETING E EVENTOS. Please remember to include your full name and address with payment. Refund Policy ~~~~~~~~~~~~ Registered delegates and accompanying persons who are unable to attend the ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ workshop will have their registration, transportation and MT-DIW5 fees ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ refunded, provided written notification is received at Meta Marketing on or ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ before July 1st. We shall retain an administration fee of 20%. After this ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ date deposits are not refundable. Refunds will be paid after the workshop. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~