Name: Company: Position: Address: Zip

REGISTRATION FORM
Name:
Company:
Position:
Address:
Zip-Code:
City:
Country:
Phone:
E-mail:
Registration Fee
IAPG and IAPG Houston Members
Non- Members
U$S 250
Credit card
□ Amex
U$S 300
□ MasterCard
□ Visa
Card number:
Expiration date:
Card holder’s name:
Security code:
Issuing Bank:
Signature:
□ Bank Transfer in Argentina payable to “Instituto Argentino del Petróleo y del Gas”, current account
denominated in pesos, Banco Patagonia 0317-3101-0594/0. CBU: 0340317200031010594003. CUIT:
30- 53772400-1.Suc. Calle Tucumán, Tucumán 885 (1049) Bs. As. (please send bank transfer receipt
by fax or e-mail).
□ Bank commissions must be included. International Bank Transfer. Please transfer to: BANCO
PATAGONIA SA, Argentina, Av. Perón 500 CP. 1038 AAJ. Acc. Holder: Instituto Argentino del
Petróleo y del Gas. ACCOUNT: 31010594/000 Swift address: BSUDARBA Through Bank
Correspondent: WACHOVIA BANK NA, New York. Swift address: PNBPUS3NNYC
Please send this form to:
Jorgelina Furios
IAPG
e-mail: [email protected]
No telephone cancellations shall be accepted. Cancellations shall be authentic and must be requested in writing.
Cancellations requested before May 9, 2016 shall be refunded ten days following the event closure with a 20%
discount corresponding to administrative expenses. Cancellations requested after that date shall not be
refunded. Vacancies shall only be reserved against registration payment.