.::TAE PERU::.

Reservation Format

Please fill the following form to make your reservation on-line. Also you can click here to download the reservation form to your hard drive and send it by email informes@taeperu.org or to the fax number (51) (84)274443.

Personal Information
*Full name:	(as shown on passport)
*E-mail:
*Place and date of birth:
Profession:
Address:
City:
State:
Post code/zip code:
*Country:
Phone:
Office Phone:
Mobile/Cell:
Fax:
*Passport number:
*Place of issue:
*Date of issue:
Expiry date:
*Nacionality:
Gender:
Do you have any dietary requirements?
Do you have international health insurance/travel insurance?	(please specify the name of the insurance company)

Emergency contact details
Full name:
Phone:
E-mail:

I have read and understood the Terms and Conditions of participating in the International Seminar with TAE Peru.
* Marked fields are mandatory