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 First & Middle Name*  

 Last Name* 

 E-mail *   

 Please verify email*  

 Address *     

 City *   

 State *    

 Zip*        Country *      

 Age *      Marital Status *         

 Race *

Day Phone including code area       

 Evening Phone including code area 

 Please select the Membership Plan you have chosen *  - prices are in US dollars -

Note: VivaAmar Membership Plan Prices does not include Airfare and Hotel expenses.

   

Note: You must confirm your choice of date trip at least 1 month prior your departure.

 Trip Departure*:             

                                                                                              

 Days in Buenos Aires * 

Please tell us what hotel do you will stay:

  Note: We can suggest you some Hotels or Apart where to stay.

 Nightly hotel budget   

 Weekly Appart budget 

 How did you hear from us?  

 Comments / Questions *

                       

I have read and understand the following: VivaAmar Inc., its employees, and matchmakers are responsible only for offering the services described, and will not be held responsible for accidents, injuries, or legal consequences (arising from the indiscretions on the part of the participants or external factors). VivaAmar Inc. reserves the right to terminate members from the service at any time due to improper conduct. I also affirm that I am not presently married. I hereby give permission to VivaAmar Inc. to use appearances of me in personal interviews in order to find possible  female candidates to meet in Buenos Aires. I will send my non-refundable deposit for this personal service. I agree to pay the balance of this service when I arrive to Buenos Aires.