AFRICA TRAVEL ASSOCIATION EIGHTH CULTURAL AND ECOTOURISM SYMPOSIUM KAMPALA, UGANDA OCTOBER 24 THROUGH OCTOBER 29, 2004 REGISTRATION FORM Please return the completed form to: The Africa Travel Association, 347 Fifth Avenue, Suite 610, New York, NY 10016 Tel: (212) 447-1926 · Fax: (212) 725-8253 · Email: africatravelasso@aol.com   LAST NAME _____________________________________ FIRST NAME _______________________________ NAME OF ORGANIZATION OR COMPANY __________________________________________________________ ADDRESS __________________________________ TEL: ( ) __________________ FAX: ( ) __________________ CITY ________________________________ STATE/COUNTRY __________________ ZIP CODE__________________   ATA MEMBERSHIP CATEGORY: Active (___) Allied (___) Associate (___) Section II. NAME OF SPOUSE OR DELEGATE SHARING ROOM (For "DOUBLE" registrants, please note: Confirmation is subject to receipt of separate registration forms and full payment for both registrants &emdash; securing a roommate is the responsibility of the delegate) LAST NAME ________________________________ FIRST NAME ________________________________ Section III. SYMPOSIUM AND ACCOMMODATION FEES Registration fee includes all Symposium functions, five nights hotel accommodation (October 24-28, 2004) at the Nile Hotel & Conference Center, Kampala, Uganda. Hotel assignments are made upon the receipt of your Registration Form on a space-available, first come, first served basis at the sole discretion of the Africa Travel Association. Full payment must be made in order to receive confirmation of registration and eligibility for airline discount. Payment of registration fees may be made by check or charged to American Express. Payment, made by check in U.S. dollars, must be drawn on a United States bank and be made payable to the Africa Travel Association. Overseas registrants may effect their payments through bank transfer in United States dollars to the Africa Travel Association c/o Fleet Bank USA at 592 Fifth Avenue, New York, NY 10036, Account Number 2101-62-5661, bank transfer number 021-200-339, bearing the words "without charges to the beneficiary". NILE HOTEL & CONFERENCE CENTER, KAMPALA: EXECUTIVE SUITE SINGLE $1,050.00 U.S. $ EXECUTIVE SUITE DOUBLE PER PERSON - $850.00 U.S. $ SINGLE $850.00 U.S. $ DOUBLE (Please check one) PER PERSON - $650.00 U.S. $ Twin Bed - on request Double Bed Add $50 handling fee for credit card registrations $ Add $75 for registrations and/or full payment received after September 24, 2004 $ TOTAL DUE: $ Enclosed is my check/money order payable to ATA, in the amount of $ as payment in full. Charge full amount to American Express Card # Exp.Date Cardholder's Name: Signature: CANCELLATION POLICY: Cancellations must be submitted in writing and will not be accepted by telephone. Any cancellation postmarked at least 60 days before the date of the Symposium will be fully refunded less a $75.00 administrative fee. Any cancellation postmarked at least 30 days before the Symposium will qualify for a 50% refund of the total Registration Fee less the administrative fee of $75.00. No refunds will be made nor will cancellation be accepted which is postmarked less than 30 days before the Symposium.   Section V. SIGNATURE Your registration will be considered incomplete if it is received without your signature. By signing this form you confirm that you have read and agree to the Terms and Conditions of the Symposium Registration which appear on the reverse side of this form and that you ask that the correct amount of the registration fees be charged to your American Express card if you so indicated above. DATE OF APPLICATION SIGNATURE Section I. DELEGATE INFORMATION