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Registration Form
Corrosion and Protective Coatings for Water Resources Structures
International Hands-on Training
(Postponed)
Denver, Colorado, USA

Training Details

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 is $2,900 and must be received by ____________.

Registrations received after __________ is $3100.

Note:   If you are also attending the Concrete and Concrete Repair for Water Resources Structures 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 your 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:

                                                                                     
Wire Transfer SWIFT Method
(a) Bank: Treasury NYC (Federal Reserve Bank) Account Name: Bureau of Reclamation
(b) City: New York City, New YorkAccount Number: 3058-5687
(c) ABA: 021030004 (Bank identifier)ABA: 021000089
(d) ALC: 14060905 (Reclamation's Account Number) Bank Name: Citibank
(e) Reference: International Corrosion and Protective
   Coatings for Water Resource Structures
Swift Code: CITIUS33 
 POC # 302-325-6196
A1R-1465-8854-0200-0000 (9)