Registration Form
Safety Evaluation and Visual Inspection of Existing Dams
International Technical Seminar and Study Tour - 2010
Seminar and Study Tour Information
Please return this form by mail to the Bureau of Reclamation, International Affairs - Denver, P.O. Box 25007, Denver, CO 80225, or fax to (303) 445-6322.
Registration fee for seminar and study tour is $3200.
Name____________________________________________________________________________
Title or Position_____________________________________________________________________ Passport Number______________________________ Date of Birth___________________________
Agency/Organization_________________________________________________________________
Office Mailing Address_______________________________________________________________
City______________________________________ Country__________________________________
E-mail address___________________ Office Telephone _________________Fax________________
Home Telephone (for emergencies) _____________________________________________________
HOTEL ROOM PREFERENCES: Arrival date ___________________ Departure date_______________
___Single __Double ___Smoking __ Non-smoking
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)
Optional tour of Rocky Mountain National Park. _____ Yes _____No
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 bank check, credit card, or wire transfer to address given below. Please indicate your payment method.
1. _____ Bank Check
2. Credit Card Number____________________________________________________________
Name on the card ____________________________________ Expiration Date _______________
SVC#________________
3. ______Wire transfer (If paying by wire transfer the seminar cost is US$3225). Please provide the following information to your bank)
1) Bank: Treasury NYC (Federal Reserve Bank)2) City: New York City, New York
3) ABA: 021030004 (Bank identifier)
4) ALC: 14060905 (Reclamation’s Account Number)
5) Reference: Bureau of Reclamation International SEVIED,
A1R-1465-8850-011-00-0-0 (9)
Updated 09/17/09