America Palm Oil Council

Registration	(* Required Information)
First Name*
Last Name*
Title
Company/Institution*
Address*
City*
State*
Postal Code*
Country
Phone Number*	(numbers only ex 3109443910)
Fax Number*	(numbers only ex 3109443544)
Email*

Hotel Reservation*
Gaylord National Hotel & Convention Center, National Harbor, Maryland
Limited Availability - $214 + Tax/Night		Yes No
If yes, please indicate dates:
Check-In
Check-Out	Other dates:
For alternate hotel accommodation, you are kindly advised to make your own arrangement.

Registration Payment
US$450.00 (price includes all meetings, lunches and cocktail reception only) All registration fees are to be paid in U.S. dollars. All registrations will only be confirmed upon receipt of payment. $50 off for registration before August 31, 2011 Cancellation policy: before August 31, 2011 All cancellation after August 31, 2011 will not be reimbursed.

Payment Instructions
By Check (US Banks Only)
Please make the check payable to *American Palm Oil Council* Send to: American Palm Oil Council 1010 Wisconsin Ave Ste 307 Washington DC 20007

By Wire
Please wire funds to: Bank of Georgetown 1001 Wisconsin Ave Washington DC 20007 Account No.: 10-10110300 Routing No.: 054001712 (Please add USD40 for International wire transfers)

By Credit Card
MasterCard	Visa	AMEX	Other type
Name on card
Card Number
Expiration Date	(numbers only ex 1206)