ON-LINE REGISTRATION

When you click on “Send form / Enviar Datos ” at the end of this page, your registration will be sent to the organizers of the ADA Summit 2007.

It is essential thaty you provide us with your correct e-mail address as you will receive via e-mail important communcation.

Please be sure to write your own e-mail address and not a repeated one from another person who may wish to apply to participate in the ADA Summit 2007 (Should you like to include more than one e-mail addresses, please do so by adding a comma).

PLEASE NOTE:

Those fields marked with an asterisk (*) are mandatory.

After finishing filling out this form, you will see a new page containing the information you have provided. Please print this page for your personal files.

 
PERSONAL INFORMATIÓN
Passport Number / ID Card (*)
Name: (*)
Last Name: (*)
Personal e-mail address : (*)
Tittle (Mr./Ms./Dr.):
Sex:

Male

(*)
Date of Birth :

(Ej: 1978)

(*)
Nacionality:
Country of Residence : (*)
City of Residence : (*)
Province of Origin:
(If you are an International Participant please mark "internacional")		 (*)
Province of Residence:
(If you are an International Participant please mark "internacional")		 (*)
Institution / University: (*)
Mailing Address : (*)
Phone Number 1 : (*)
Phone Number 2 or fax:
DISCOUNTS
If you are applying for a discount please indicate to which one (Ex. ADA Alumni, EL COMERCIO Newspaper Suscribers, Institutions with an ISO Certification)

PRACTICAL INFORMATION
I wish that on my Certificate of Participation my name be written like this: (Your Certificate will be automatically written using this section)
(*)

INVOICE INFORMATION

Name of person / institution:
ID Number:
Address:
Phone number :
COMPLETION OF REGISTRATION PROCESS

Please remember that your registration will only be completed once you have paid for your registration fee in the account belonging to ADA - Auditoría Democrática Andina No.10016036469 (Banco Solidario), and you have sent the deposit slip to ADA to the address or fax below. Please confirm that you have included your name.
Auditoría Democrática Andina
Joaquín Pinto E5-08 y Juan León Mera
Tercer Piso
Quito - Ecuador
Telefax: (593-2) 2553 776
inscripciones@auditoriademocratica.org

You may also pay for your registration fee by using a credit card (VISA BANCO PICHINCHA or DINERS CLUB). At the moment this service is only available in Quito.

Note: You may also make the deposit in any SERVIPAGOS branch within Ecuador.

I have read and accept the Practical Information and Rules of Participation (*)
Click here to read this document
 
When you click the button "SEND FORM" (Enviar Datos) , all the information provided in this form your application will be processed.

Following, you will be sent to a new page that may be saved or printed for your personal information. This process may take a few seconds


 
ADA – Liderazgo & Opinión
Joaquín Pinto E5-08 y Juan León Mera. 3er piso.
Quito - Ecuador
Telefax: (593-2) 255 3776