Eisenhower Fellowships

How to Register:

ONLINE REGISTRATION

Fill the Registration Form properly with all the required data.
Check your data.
Click on the "Send" button only once.

ATTENTION!
Your registration will only be effected after acceptance from your credit card company or after receiving the deposit account statement, according to the chosen payment option.

Registration Form

Required fields are indicated with an asterisk (*)

Registrant Information

Participant Information

Salutation Prof. Dr. Mr. Mrs. Ms .

First Name*
Last Name*
Name exactly as you want it on name badge*
Current Professional Position
Organization Name

Guest Information

My guest is:
Spouse/Partner Other

First Name
Last Name
Name exactly as you want it on name badge

Special Services

Please indicate required special servces
(e.g.: wheelchair accessible, transportation, dietary restrictions, allergies)

Contact Information

Address

Adress*
City*
State / Province*
Postal / Zip Code*
Country*
Office Telephone* Country Code Area Code #
Mobile* Country Code Area Code #
E-mail*

Company Adress

Company
Address*
City*
State / Province*
Postal / Zip Code*
Country*

Registration Fees

Conference Registration Fees

I am an Eisenhower:
Fellow Speaker Other
I Taking a:
Spouse/Partner Other

Individual	$ 400.00
Spouse/Partner	$ 250.00
Young Future Leaders*	$ 100.00
Speaker / Panelist	No fee

Total Enclosed: $

* Recently graduated or post-graduated, aging between 25 to 30, with potential and interest in become a Eisenhower Fellow.

Workshops

I intent to participate the following workshop:
Click here to view all workshops names on the program.

Option 1
Name

Option 2
Name

Payment Information

Registration Payment Options

Credit Card

You can register using your cretid card.
Registration must include number and security code of your credit card.

Please note that your registration will only be completed after acceptance from your credit card company.

Deposit Account

Bank Name: Bradesco
Bank ABA number: 237
Name of beneficiary: Rhodes Eventos / Eisenhewer
Number agencia: 513-4
Beneficiary account number: 80248-4
Swift code: BBDEBRSPBHE

Please note that your registration will only be completed after the receivement of deposit account statement.

ATTENTION!

1- All payments must be in US dollars.

2- Please fax this completed form properly along with card data or deposit statement, according to your payment option of choice.
Please note: Registration will not be processed without full payment.

Fax:
55 31 3227 1011

Mail:
Eisenhower Fellowships
Rua Tomé de Souza, 67 - seg. andar Funcionários
Cep: 30 140 131 - Belo Horizonte, MG

Credit Card Payment* Visa AMEX MasterCard

Name on Card*
Expiration Date*
Card Number*
Security Code*

REGISTRATION BY FAX

1 - Click here, and download the Registration Form (PDF File).
(The form will open with Adobe Acrobat Reader. If you don't have the software, click here to download it).

2 - Print the file, fill it, and sent it to the following fax:

55 31 3227 1011

ATTENTION!

1 - If your chosen payment option is Deposit Account, you must send, also, a copy of the statement, so your registration can be validated.

2 - If your chosen payment option is by Credit Card, your registration will only be validated after acceptance from the credit card company.

Secretaria Executiva
Rhodes Eventos - Rua Tomé de Souza, 67 - 2o Andar - Funcionários - Belo Horizonte/MG - Fone: (31) 3227 8544