1. Healthcare

Please Return until August 30, 2015
Asociación Panameña de Gestión de Proyectos (APGP)
Bldg. 235, Suite 2p, City of Knowledge, Clayton, Panama
Phone (507) 317-9017, email: [email protected]
REGISTRATION FORM
29th IPMA World Congress Panama 2015
Hotel Westin Playa Bonita, September 28-30, 2015, Panama
Please note that the organizer would prefer online registration at: www.ipmawc2015.com
PLEASE USE BLOCK CAPITALS – PLEASE USE ONE FORM PER PARTICIPANT
A. PARTICIPANT INFORMATION
Please Mark
Mr.
Ms/Mrs.
Professor
Dr.
Family Name
General Information and Address
First Name
Organization / Institution
Street
No.
Country
IPMA Member Association (if Applicable)
Country+Area Code No. Phone No. (during work hours)
City
E-Mail
What age group do you belong to? (please mark)
under 20 years
50-59 years
20-29 years
60-69 years
30-39 years
over 70 years
Do you come accompanied? (please mark)
YES
NO
Shirt Size (To be provided for IPMA B-Day Fest)
Small
Medium
40-49 years
Large
XL
XXL
XXXL
B. REGISTRATION FEES (Fees below are inclusive of any applicable taxes and are quoted in
US dollars and in Euro for reference only.
IPMA Guest*
Keynote or Track Speaker
Sponsor**
IPMA Member Participant***
Non-Member Participant
Student or Young Crew***
Until June 30, 2015
PROM CODE
PROM CODE
PROM CODE
$795.00
$914.00
$450.00
Advance Course Workshop (Day Ticket)
$450.00
IPMA Award Gala Ticket
$150.00
After June 30, 2015
$914.00
$1,050.00
$518.00
SEP-29
SEP-30
* I certify to be entitled to the special registration fee. In order to be eligible for the special fee, you have to receive from IPMA
secretariat a special IPMA Code. The deadline to sign up for a special IPMA Guest is August 31, 2015!
** I certify
be entitled
to a special
registration
Code during Registration).
IPMAto50th
Annversary
B-Day
Ticketfee (include Discount
$100.00
*** I certify to be entitled to the reduced registration fee. An appropriate proof of status is attached to this registration form
([email protected])
C. LATNET ADVANCE COURSE IN PPPM WORKSHOPS
During the Congress, there will be a special separate product that will be available on September 29 and 30. The
participants (one day) will be granted access to the Business Agora exhibit between 10:00 AM to 3.00 PM to
attend the Advance Course in Project Program Portfolio Management (ACPPPM) which is composed of four
(4) workshops. These will not have access to the WC2015 neither the PMX2015 program. The ACPPPM
includes lunch with Congress participants.
Advance Course Workshop (Day Ticket)
$450.00
SEP-29
SEP-30
D. EVENING EVENTS
WC2015 evening events are part of the program as optional for participants. (Please take note that
registration fee for the WC2015 includes one (1) ticket to the IPMA 50th Anniversary B-Day Fest).
The IPMA Award Gala Dinner will take place on September 29, 2015 at 8:30 PM. The IPMA 50th
Anniversary B-Day Fest will take place on September 30, 2015 at 8:30 PM (Special Shirt will be
provided, please fill size in registration form). The Fest will be an ALL WHITE party, we recommend
you bring a white pant. Additional shirts (limited number) will be available at congress Registration
Desk. For Both events booking in advance is requested.
IPMA Award Gala Ticket
IPMA 50th Annversary B-Day Extra-Ticket
$150.00
$100.00
GRAND TOTAL :_______________________________( USDOLLARS)
(Add USD10 for Manual Registration fee)
E. METHOD OF PAYMENT
Payments can be made:
 by credit cards (American Express, MasterCard, Visa),
 by direct wire transfers to APGP Bank Account (see instruction).
 On site payments can also be realized in electronic Transfer or in Cash at APGP
Congress Office (see instructions).
For payments made by credit card, the credit card statement vendor/merchant will be shown as
Simply Eventful Management. The statement will show the equivalent US dollar fees in the
home currency of the registrant.
Registrations received by hard copy form are subject to a US $10 fee. Payments made by wire
transfer will also incur a US $50 bank transfer fee.
PAYMENT BY CREDIT CARD
Please Mark type of Card
Master Card
Visa
American Express
With my signature, I authorize APGP/LATNET to charge my credit card upon confirmation with the GRAND TOTAL
shown above (include USD10 manual registration fee)
General Information of Document
Card Holder Name ( As printed in Card)
Card Number
Expiration Date
CVV2/CVC2(required)
CVV2/CVC2:Visa/Master Card 3-digits by the signature on the back of the card. Amex 4-digits number printed above the card
number on the front.
PAYMENT BY WIRE TRANFERS
For Payment using Wire Transfers, you should submit the GRAND TOTAL (plus USD50
banking fees) to:
Transfer to
For Credit to
to the account
CITIBANK NEW YORK, N.Y.
SWIFT CITIUS33
ABA 021000089
BANCO GENERAL, S.A. - PANAMA
SWIFT BAGEPAPA
No. 10951934
ASOCIACION PANAMEÑA DE GESTION DE PROYECTOS
No. 03-95-01-078027-7
Copy of the wire transfer voucher shall be sent with registration form electronically.
LOCAL PAYMENTS (IN PANAMA)
For Payments in Panama, you can use ACH systems to transfer the payment (no banking Fee) to:
BANCO GENERAL, S.A. CUENTA CORRIENTE NO. 03-95-01-078027-7 to the name of
ASOCIACION PANAMEÑA DE GESTION DE PROYECTOS (APGP) for the GRAND
TOTAL and submit screenshot of payment with registration form.
Or you can visit of APGP Congress office at Building 235 suite 2P at City of Knowledge, Clayton Panama, Monday
through Friday, 9:00 AM to 4:00 PM to pay the GRAND TOTAL. Bring the print of your registration properly
filled.
I hereby allow my details to be passed on to sponsors and exhibitors at the 29 th IPMA World Congress Panama
2015.
I accept, (on behalf of and including all above mentioned persons) the general terms and conditions and the data
protection provisions. I agree that my/our personal data may be used within the scope of this meeting. I agree,
where necessary, that this data may be transferred to 3rd parties (e.g. hotels, travel agencies, airlines etc.) that
are involved in the organizational process. I agree that our contact details may be used to promote any events
organized by IPMA or LATNET. (This includes email newsletters, or mail distribution etc.) The collection,
processing and use of this data is carried out in compliance with the Panamanian data protection laws, and
under the supervision of our data-protection representative. I understand that I may deny the promotional use of
my/our personal details by crossing out this paragraph or by contacting APGP directly: Tel. (507)317 90 17 –
standard tariff), Email: ([email protected]).
I / We agree to electronic credit card cashing and accept the stated terms and conditions.
Date:_____________________
Signature:____________________________________
Registration / Confirmation / Cancellation Deadline for Early Bird
Registration is June 30, 2015. Registration and services booked can
only be confirmed upon receipt of full payment or valid credit card
details. In case of cancellation of participation until June 30, 2015,
registration fees will be refunded. A handling fee of USD50,– per
person will apply. Cancellations received in writing between July 1,
2015 and August 30, 2015 will be refunded, less a 25% administrative
fee. Cancellations received in writing on August 31, 2015 or later, will
not be refunded, other than exceptional circumstances to be reviewed
and agreed by the organizing committee. Name changes incur a
handling fee of USD10 – per registration. In case of no-show or early
departure no refund of registration fees will be made. The organizers
will only accept request for refunds if they are in writing. Should you
have any special requests for the processing of your invoice, kindly let
us know when submitting your registration form. The re-issuing of an
invoice incurs a USD10 – handling fee. All prices and details, beyond
our control, are subject to change. Name Badge Replacement Policy
Participants can only collect their name badges upon arrival at the
congress from the registration area. If the badge is lost, a replacement
badge will be issued at a charge of USD5.
It is mutually agreed that in the event of total or partial cancellation of
the congress due to fire, strike, natural disaster (either threatened or
actual), government regulations or incidents not caused by the
organizer, which would prevent its scheduled opening or continuance,
this agreement may be partially postponed or terminated as a whole.
In this case, participants are not entitled to reclaim refunds on no
account. Participants are obliged to have a civil liability insurance. In
the case of cancellation, a timely shift or changes in the duration of
the event, the registration remains its validity.
Social Program / Evening Events: Each program/event requires a
minimum number of participants. If the minimum number is not
reached until 14 days prior to the meeting, the program/event in
question will be cancelled and a full refund will be given. Should an
individual cancel their own participation, no refund will be issued.
Participants take part in all programs/events at their own risk. /
Confirmation / Cancellation Deadline for Early Bird Registration is
June 30, 2015.
Legal Conditions: The organizer of this event is APGP/LATNET. The
scientific program is under the responsibility of the scientific
committee. These general terms and conditions and all subsequent
information are to be considered as the legal basis for all
registrations. Verbal agreements are not binding, unless confirmed
in writing. All vouchers/documents will only be distributed upon
receipt of full payment. Please pay any balance on time, as indicated
on your invoice. There will be no refund or replacement for lost or
unused vouchers /documents. The participant acknowledges that he
/ she has no right to lodge damage claims against the organizer
should the meeting or parts hereof be hindered or prevented by
unexpected political or economic events or generally by force
majeure, or should the last-minute cancellation of speakers or other
reasons necessitate program changes.