tar debates registration form
DESCRIPTION
The Africa Report Debates Registration form Africa's developmentTRANSCRIPT
A unique plAtform to engAge on AfricA’s developmentAccrA, ghana 20th november 2015
debatesTough talk on development
1. profile of pArticipAntsTHE AFRICA REPORT DEBATES is open to Mo Ibrahim delegates and interested parties.confirmation of your registration will be sent on receipt of this form and payment, provided you fulfill the admission criteria.
2. BooKing
Category Price (incl. VAT) Quantity Total
2015 delegates € 200 1
mo ibrahim delegates * 1
TOTAL
Benefits: Admission to THE AFRICA REPORT DEBATES 2015 includes all documentation, welcome drinks, snacks and the cocktail party. in case of cancellation by the participant for whatever reason, no refund will be granted by the organizer, but a substitute delegate can be named (subject to approval by the event organizer). After you register, you will receive a confirmation email containing payment methods and all further information about your participation in THE AFRICA REPORT DEBATES. * contact Alison Kingsley-Hall on [email protected]
3. compAnYname ____________________________________________________ sector ____________________________________________________
if your company is part of a group, please indicate the group’s name _______________________________________________________________
Annual turnover: < 10 million euro 10 to 50 million euro 50 to 100 million euro > 100 million euro
employees: < 50 people 50 to 250 people 250 to 500 people 500 to 1,000 people > 1,000 people
full address _________________________________________________________________________________________________________
postal code _____________________________ town ___________________________________ country ___________________________
fax ___________________________________ Website ____________________________________________________________________
4. contAct detAilsa) Personal details
title ___________________________________________________________________________________________________________
first name ______________________________________________________________________________________________________
last name ______________________________________________________________________________________________________
company _______________________________________________________________________________________________________
position ________________________________________________________________________________________________________
phone _________________________________________________________________________________________________________
email __________________________________________________________________________________________________________
b) Person to contact in case of absence
title ___________________________________________________________________________________________________________
first name ______________________________________________________________________________________________________
last name ______________________________________________________________________________________________________
company _______________________________________________________________________________________________________
position ________________________________________________________________________________________________________
phone _________________________________________________________________________________________________________
email __________________________________________________________________________________________________________
i would like to attend THE AFRICA REPORT DEBATES. i would also like to learn more about THE AFRICA REPORT DEBATES sponsorship opportunities. please send me the full sponsorship documentation.
Is there anyone you would like to invite to the debate? if so, please include their name and contact details below, and we will send them an invitation.
name and surname _____________________________________________________________________________________________
email ________________________________________________________________________________________________________
mobile number ________________________________________________________________________________________________
Name: Date: Signature:
PRE-REGISTRATION FORM
Completed and signed form to be returned by email to [email protected]