Name:
___________________________________ Member ID#:
________________
Company/Agency Name:
_________________________________________________________
Company/Agency Address:
____________________ Home Address:
___________________
____________________
___________________
____________________
___________________
Contact Phone:
_____________________
E-Mail:
____________________________________________________________
____ I am including a check
payable to: ISACA Puerto Rico, for the amount of $ __________
or
____ I hereby authorize
ISACA Puerto Rico to charge my VISA or MC credit card with the
information provided
below for the amount of: $
__________.
Card number:
_______________________________ Exp Date: __________
Your name as appear in
credit card: __________________________________
Your authorized signature:
_________________________________________
The price
includes study/reference material, 6 CPE certificate, breakfast,
lunch, breaks, visiting sponsors’ booths. Group of 10 or more,
same company, pay $150 per participant. Cancellation penalty:
50% of amount paid. Be a member and take discount offers.
Special corporate rates for non-PR residents, included in
webpage.