INDIVIDUAL REGISTRATION FORM

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					                              INDIVIDUAL REGISTRATION FORM
                           2012 CIOR/CIOMR SUMMER CONGRESS
                       30 July–3 August, 2012 / Copenhagen, Denmark

1. PERSONAL INFORMATION
First Name:_____________________ Last Name: _______________________ Rank: ______________
Branch of Service: _________________ Gender:       Male Female     Date of Birth:
______________
Place of birth: _________________________________ Passport / ID No. ________________________
Home Address:_______________________________________________________________________
City: ________________________ State:_________ Zip Code: _____________ Country: ___________
Telephone No. _________________________ GSM NO. ____________________________________
Email Address:_______________________________________________________________________

2. ACCOMPANYING PERSON
Full Name: __________________________________________________________________________

3. OTHER IMPORTANT INFORMATION
Dietary Requirements: _________________________________________________________________
Accessibility Requirements:_____________________________________________________________
Blood Type: ___________________ Medical Insurance Company: ______________________________
Emergency Contact (Name & Telephone No). ______________________________________________
___________________________________________________________________________________

4. STATUS
Check appropriate status box: CIOR        CIOMR
If CIOR, please specify the committee or group below:
       COUNCIL         CLAC        CIMIC          DEFSEC     LEGAL  PFP&O 
YROW
       SWG  MILCOMP  PERMREP  WINTER SEMINAR  OBSERVER 
DAL

5. TRAVEL
Arrival:    Air     Train     Bus      Car    Date: ________________ Time:
_________________
Flight No:____________ or Train/Bus Station:______________________ Car Plate No:_____________
Departure:    Air  Train  Bus  Car             Date: ________________ Time:
_________________
Flight No:____________ or Train/Bus Station:______________________ Car Plate No:_____________




6. REGISTRATION FEES
Registration fees are based on your status–please review the status categories carefully to ensure you
choose correctly. Early mailed registrations must be received by 1 May. After 1 May you must pay the
late registration fees. You may also register online at http://www.roa.org/Copenhagen until midnight 1
May to get the early registration rates.

CIOR (Early Registration: $875 – After 1 May: $950)

CIOMR (Early Registration: $875 – After 1 May: $950)

7. ACCOMMODATIONS
In order to book your stay in Copenhagen, please use hotel booking forms which can be found at
http://www.roa.org/Copenhagen. Send your hotel reservation form by email to: CIOR@intouch.dk or fax
to 011 45 70 27 27 21 . You can reach the In Touch company by phone 011 45 70 27 27 20. There is
no mailing address so use email or fax.


10. REGISTRATION SELECTIONS & PAYMENT
Payment by check or Money Order made out to “Reserve Officers Association: or credit card. Please
make your choices carefully to avoid overpayment.
STATUS
    CIOR                        Early: $875       Late: $950                  $ ______________

    CIOMR                       Early: $875       Late: $950                  $ ______________
                         TOTAL REGISTRATION FEE:                              $________________
Payment Type
    Enclosed is my Check or Money Order for the full registration fee : $_______________
    Charge full registration fee to my:  American Express  Discover  VISA 
MasterCard
Name on Card: __________________________________________ Expire date:________________
Card No: _______________________________________________ Card Security No: ___________

11. REGISTRATION CANCELLATION POLICIES
Registration fees are non-refundable but may be transferred to substitute delegates if affected NLT 15
July.

Mail completed form and payment to: ROA Attn: CIOR-Copenhagen
                                    One Constitution Avenue, NE
                                    Washington, DC 20002
FAX completed form to:              202-646-7767

				
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