Registration form INTERNATIONAL BRAIN INJURY ASSOCIATION PAN AMERICAN HEALTH ORGANIZATION BRAZILIAN BRAIN INJURY SOCIETY SARAH NETWORK OF HOSPITALS FOR THE LOCOMOTOR SYSTEM   SEPTEMBER 13-16, 2000 SARAH BRASÍLIA HOSPITAL BRASÍLIA BRAZIL

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Registration Fees		All payments must be made by certified check, money order, or credit card (American Express/Visa/Mastercard) to the SARAH Network of Hospitals for the Locomotor System (address below). Payment must be in US Dollars.
		Per Person (US$) Total Early Registration IBIA, BBIS, SARAH Members Non-members  Fee until:  April 30, 2000 R$ 461.00 (US$265.00) R$ 496.00 (US$285.00) Late Registration Fee after: May 1, 2000 R$ 496.00 (US$285.00) R$ 531.00 (US$305.00)        OPTIONAL EVENTS: Gala Dinner: R$ 61.00 (or US$35.00)/per person
Important for internet submissions		Registration will only be confirmed after receipt of payment forms, which must be mailed to the address below. (   ) Mastercard (   ) American Express (   ) Visa Name: Card Number: Expiration Date: / / Total Amount: Signature: Date: / / Complete and return form to: The SARAH Network of Hospitals for the Locomotor System, SMHS Quadra 501 Conjunto A Terreo, 70.330-150 Brasília/DF BRAZIL.