Registration Form

Registration Form

Academic	Student
Seniors	Professional or technician working w/elderly

Please make a selection

Name:

Last name:

Ocupation:

Institution / Department:

Adress:

Zip:

City:

Country:

ID / Passport:

E-Mail:

Personal E-mail (optional):

Telephone (country code/area):

Fax:

Registration Fees

Before July 30th 2010
Regular:	CLP 50.000 / USD 100
Students:	CLP 25.000 / USD 50
Seniors:	CLP 15.000 / USD 30

After July 30th 2010
Regular:	CLP 60.000 / USD 120
Students:	CLP 35.000 / USD 70
Seniors:	CLP 20.000 / USD 40