9TH APSSIR REGISTRATION FORM
Registration Deadline: May 31, 2003


Full Name
(please underline surname)
Accompanying Person
 
Institution
Correspondence Address
 
City
Postal Code
Country
Office Telephone
 Fax
E-mail

SECTION A: REGISTRATION FEE
  EARLY LATE ONSITE Payment
On or before
May 31, 2003 		After
May 31, 2003 		   
Delegate

Resident

Accompanying Person 		US$ 400

US$ 250

US$ 100 		US$ 450

US$ 300

US$ 150 		US$ 550

US$ 350

US$ 250 		US$ __________

US$ __________

 US$ __________

TOTAL

US$ __________


SECTION B: HOTEL ACCOMMODATION

No. Hotel Room Category Single Double/Twin Room Type
(Pls. specify)
Waterfront Cebu City Hotel
(Meeting Site & Headquarters Hotel)		 Standard/Superior
Deluxe
Ambassador		 US$ 98
US$ 109
US$ 120		 US$ 109
US$ 120
US$ 142
Single
Double
Twin
Cebu City Marriott Hotel Deluxe Business
Deluxe		 US$ 82
US$ 93		 US$ 82
US$ 93
Single
Double
Twin
Cebu Midtown Hotel Standard/Superior US$ 43 US$ 33
Single
Double
Twin
Shangri-La's Mactan Island Resort Deluxe Seaview US$ 175 US$ 175
Single
Double
Twin
Plantation Bay Resort Superior Waterview
Superior Waterside		 US$ 152
US$ 174		 US$ 168
US$ 190
Single
Double
Twin

Note: Above rates are inclusive of breakfast, service charge and government tax. A one-night room deposit equivalent to the applicable net rate of your 1st choice hotel must accompany the booking form to guarantee accommodation at the quoted preferential rate. Forms and deposits must be received before August 01, 2003 to secure the above rates.

Hotel Room Information

I require ______ room(s) for ______ nights

Check-in Date ____________  Check-out Date ____________
Arrival Date
 Flight No. & Arrival Time
Departure Date
 Flight No. & Departure Time

Airport Transfers
I will require: Roundtrip transfers - US$40 One-way only - US$20 No transfers


SECTION C: GOLF TOURNAMENT REGISTRATION

 US$ 125.00 per person


SECTION D: ACCOMPANYING PERSON'S TOUR REGISTRATION
 In addition to the official social functions, all registered Accompanying Person(s) are entitled to the following complimentary tours. Additional tickets for these tours could be purchased at the TOUR REGISTRATION COUNTER.

Accompanying Persons' Tour Date Time Total Number of People
Cebu City Tour 01 Oct 1000-1400H  
Arts & Crafts Tour 03 Oct 0800-1200H  


Payments
Please take note that bank charges are to be borne by the participants and not to be deducted from the amount remitted to 9th APSSIR.

Payment Details Amount
Registration Fee US$
Hotel Deposit US$
Airport Transfers US$
Golf US$

Total

 US$


Method of Payment

  Bank-to-bank transfer

Payments for registration fee, exhibit fee and golf:
Account: PHILIPPINE UROLOGICAL ASSOCIATION, INC.
Bank: PHILIPPINE NATIONAL BANK
Account No: FX 262-706971-8
Swift Code: PNBMPHMM
Address: Q.C. Circle Branch, Elliptical Road cor.
Kalayaan Avenue, Diliman
Quezon City, Philippines

Payments for hotel deposit, airport transfers and tours:
TO: BANK OF NEW YORK
ABA # 021000018 
swift Address: IRVT US3N
Chips UID 367800

For credit to the account of:

INTERNATIONAL EXCHANGE BANK
Account No. 890-0299-886
Tektite Branch, Exchange Road
Ortigas Center. Pasig City. Philippines 1605

For further credit to Dollar Account No. 006-10-1-01382-0 Under WORLD UNLIMITED CONVENORS CORP.

  Credit Card
Credit Card Type   Visa Mastercard
Credit Card No.  
Expiry Date  
Bank Name of Cardholder  
Billing Address of Cardholder  
Amount to be Debited to Credit Card (US$)  
 
Signature of Cardholder  
Date
 Passport No.

(For Visa and Mastercard ONLY Please add 5% surcharge to the total amount Please attach photocopies, FRONT & BACK, of your credit card.)