2nd Latin American School and Workshop on Polynomial Systems

Angra dos Reis, RJ, Brasil - Feb 28 to March 4, 2005


(Portogalo Suíte Hotel)

Please print, fill and send by FAX to: Michele Leite, CMO Eventos, 55-21-2210-1730. Suggested arrival and departure dates: Feb 27 and March 4. This form is only for non-brazilian residents not currently supported by Brazilian sources.

Full Name:

Arrival date:

Departure date:

Acompanyning persons:

Type of occupancy:

( ) Single R$ 220,50/night

( ) Double R$ 304,50/night

( ) Triple R$ 441,00/night

( ) I wish to share a double room

Credit card type:

Credit card number:

Security code:

In case of no-show or cancellation, one night will be charged from the credit card account above.