Registration Form
Concrete and Concrete Repair for Water Resources Structures
International Hands-on Training
(Postponed)
Denver, Colorado, USA

Please return this form to:

Bureau of Reclamation, International Affairs – Denver
P.O. Box 25007, Denver, CO  80225
By fax number (303) 445-6322   
Email: Lprincipe@usbr.gov OR Amedina@usbr.gov

Registration fee for seminar and site visit is $2,900 and must be received by __________. 
Registrations received after __________ is $3100.

Note:   If you are also attending the Corrosion and Protective Coatings Training, __________, the total registration fee is $6,100 and includes lodging for __________.

International travel should be arranged into Denver, Colorado, no later than __________, and out of Denver, Colorado no earlier than __________.

Please submit a legible copy of your passport with this registration form.

Mr. Ms. Mrs. (circle)     Name as appears on passport __________________________________________

Title or Position__________________________________________________________________________

Area of Speciality/Expertise _______________________________________________________________

Passport Number __________________________________ Date of Birth __________________________

Agency/Organization _____________________________________________________________________

Office Mailing Address ___________________________________________________________________

City _____________________________________Country ______________________________________

E-mail Address _________________________________________________________________________

Office Telephone _________________________________ Fax ___________________________________

Home Telephone (for emergencies) _____________________ Mobile/Cell No.______________________

HOTEL ROOM Preferences: Arrival date ________________ Departure date: ____________________

_____Single ____Double      If double, Roommate Name ________________________________________

***Do you require any special services, i.e., dietary restrictions or accommodations for a disability or impairment? (Please explain your needs.)

PAYMENT METHOD:   Please note -- Funding is not available from the Bureau of Reclamation. You must seek private sponsorship, if needed.
Prepayment must be made by credit card, wire transfer or Swift Method in U.S. Currency. Please indicate you payment method.

1. Credit Card Number __________________________________________________________________

Name of credit card _____________________________ Expiration date _____________ CVC#_________

2. _____Wire transfer or Swift method (if paying by wire transfer the seminar cost is US$2925).  Please provide the
following information: