Letter of Invitation Application Form

Registration to HydroVision Brasil Conference and Exhibition and payment are required prior to receiving an invitation letter.* *Cancellation Policy: If you are unable to acquire a visa, PennWell will reimburse 100% of your registration fee if the Registration Department is notified BY FAX OR EMAIL by August 9, 2013. After this date, no refunds are available. Due to the large volume of requests for letters of invitation, please ensure the information you provide is accurate on this application. Please enter your name exactly as it appears on your passport. Male: _____ Female: ____ Nationality: ____________________ First Name: __________________________________ Family Name: _______________________________________ Title: _________________________________________________________________________________________ Organization: ___________________________________________________________________________________ Address: _______________________________________________________________________________________ ______________________________________________________________________________________ City:_________________________________State:____________________________Postal Code: ______________ Country: _______________________________________________________________________________________ Phone: (+_____) ________________________________Fax: (+_____) ____________________________________ E-Mail: ________________________________________________________________________________________ Arrival Date: _____________________________Departure Date: _________________________________________ Receipt/Confirmation # _____________________________ (This number appears on your registration confirmation. Registration and payment are required prior to receiving an invitation letter.) Please indicate whether you are: ____An Attendee ____An Exhibitor ___A Sponsor Passport Information Issuing Country: ___________________________________ Passport Number: __________________________________ Expiration Date (Month/Day/Year): ____________________ Date of Birth (Month/Day/Year): ______________________ Place of Birth:_____________________________________ Please submit this form to the Registration Department: By Fax: +1-918-831-9161 By Email: registration@pennwell.com Letter of Invitation Application