22nd WORLD FLOWER COUNCIL SUMMIT
“FRAGRANCE OF THE ARCHIPELAGO”
JAKARTA, INDONESIA
SEPTEMBER 4 - 9, 2005
SUMMIT REGISTRATION

Please print form, include ALL information below and fax to WFC:

If registering a group of delegates, please attach a separate sheet with names and addresses.

COUNTRY:___________________________________WFC MEMBERSHIP #:__________________

FIRST NAME:________________________________LAST NAME:____________________________

ADDRESS:____________________________________________________________________________

CITY:_______________________________________________________ZIP:______________________

PHONE:_____________________ FAX:_____________________ EMAIL:_____________________

__ I will represent my country during the WFC International Design Session
__ I will represent my country during the WFC Delegates Meeting

__ Summit Registration September 4 - 9 $400 USD
__ Summit Registration + Education Session September 4 $450 USD
__ WFC Membership Dues 2005 $50 USD
__ Late Registration after August 1, 2005 +$50 USD

If you wish to pay for summit registration and dues by credit card, please complete registration and credit card authorization form and fax to Dean at WFC Home Office – 480-860-0907 prior to July 15, 2005.

___ Please charge my credit in the TOTAL NET amount above.
__Credit Card: __Visa __MasterCard __Discover __American Express __

Credit Card Number:___________________________________________ Exp.:______________________

Name on Card:_________________________________ Authorized Amount to Charge:$_______________

Authorized Signature:________________________________________ Date:______________

___ I will transfer a full amount of the TOTAL NET amount above to: CENAIDJA

BCA BRANCH WOLTER MONGONSIDI
A C No. 5240120641
A C name: Els Tiwar & Elisabet Berlian Darante

Mulia Hotel Reservation
Mulia Splendor USD $105.00++ Plus 21% Government Tax and Service Charge (net $127.00)

A credit card is required by August 1, 2005 for the first night’s cost, and the balance to be paid upon checkout. A certified dollar check is acceptable if credit card is not used.

Arrival Date: ____________________ Departure Date: ____________________
Number of Rooms: __________ ___ Twin ___ Double
___ Double Occupancy ___ Single Occupancy ___ Smoking ___ Non-Smoking

PLEASE RESERVE HOTEL WITH YOUR CREDIT CARD ABOVE

EMAIL/MAIL/FAX REGISTRATION TO:
22nd World Flower Council Summit
Jl. Cipaku I No. 13 Jakarta 12170 Indonesia
ATTN: Els Tiwar
Phone/Fax: (62-21) 7267793, 7694036
Email: els_tiwar@yahoo.com

EARLY SUMMIT REGISTRATION ENDS AUGUST 1ST.
REGISTRATION COST WILL INCREASE $50 USD AFTER AUGUST 1ST.

Home Invitation to Jakarta Summit Schedule