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Registration form
First Annual Mesoamerican Birding Festival
febrero 22-27, 2009, Lake yojoa, Honduras
Please fill out one form for each participant
Complete name (as it appears on passport):
Address:
City/State/Zip/Country:
Telephone :
Age: Sex: Nationality:
Occupation:
Name of Organization:
Governmental institution
Business
NGO
Community
Sponsor
Email:
PRICE
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DESCRIPTION
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$ 365 double (Lps. 6,900.00)
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Per participant in general.
Sharing a room.
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$ 460 single (Lps. 8,700.00)
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Per participant in general. Will not share a room.
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With participants registering 3 or more people from the same organization they will receive a 10% discount.
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Information:
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How many registrations:
Amount to pay:
Names of paying participants:
FORMS of PAYMENT
Information to pay with a credit card:
Type of card: Visa________ MasterCard_______
No. of Card: Expiration Date:
Name on the card:
Amount to Pay:
MEA`s office in Colorado
Credit card numbers by telephone (303-440-3362 USA.)
fax (303-447-0815 EE.UU.)
e-mail (mark@travelwithmea.org)
Other forms of Payment
PayPal through MEA`s website (www.travelwithmea.org )
Bank Transfers in US$ dollars:
Bank: Wells Fargo Bank
Account Name: Sustainable Alliances Inc.
Account number: 5178068580
Routing #: 121000248
Swift: WFBIUS6S
Address:
Wells Fargo Bank
North Boulder Branch
3307 30th Street
Boulder, CO 80301
Tel: 303-448-3784
Direct payments with country representatives:
Robert Gallardo will be out of email communication from Jan. 27 to Feb. 14.
In Honduras: (NOTE Important: Send an e-mail to janabock@gmail.com and a scanned copy of the bank deposit slip to confirm deposit)
Lempiras: Banco Occidente
Name on account: Robert Jackson Gallardo
Account number: 21-102-009465-3
Dollars: Banco Atlantida
Copan Ruinas
Honduras
Central America
Tel. (504) 651-4505
Dollar acct. 11200188735
SWIFT code ATTDHNTE
Robert Jackson Gallardo
In Nicaragua:
(Wire transfer)
Name of intermediate bank for México y USA
Citibank, N.A., New York, N.Y./ ABA 021000089
Account with Institution BIC/36020388 (USD)
BCCENIMA Banco de Crédito Centroamericano
(BANCENTRO), Managua, Nicaragua
Beneficiary in Nicaragua: FUNDACION COCIBOLCA
Account No. 101-600-084
Address:
Residencial El Dorado, esq suroeste parque 1 c. sur y ½ c. oeste No. 127
Managua, NICARAGUA
Phone: 505 248 8234 y 35, fax 505 249 4144
If you have any questions contact:
Mark Willuhn
Telephone in the USA: 303-440-3362
Skype: mwilluhn
E-mail: mark@travelwithmea.org
Or
Robert Gallardo
Copan Ruinas, Honduras
Telephone: (504) 651-4133
E-mail: rgallardo@gmail.com
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