REGISTRATION FORM
FORMULAIRE D’INSCRIPTION
20th African Reinsurance Forum / 20ème Forum de la Réassurance Africaine
Lilongwe – Malawi
12th to 15th October 2014
SOGECOA GOLDEN PEACOCK CONFERENCE CENTRE
Please type or print in block letters and complete one form per delegate/Utiliser les lettres majuscules et remplir une fiche par participant
First Name/Prénom: ………………………………………. Surname/Nom:……………………………………….. Mrs/Miss/Mr/M/Mme/Mlle(*)
Company/Organisation/Compagnie:…………………………………………Function/Title/Fonction:…………………………………………
Address/Adresse……………………………………… City/Ville:……………………………………… Country/Pays: …………………………..
Telephone: ………………………………..…………….. Fax: …………………………………………………………………………………………
Email: …………………………………………………………………… Passport N°. ………………………………………………………………..
Issued at/Delivré le:………………………………………. Valid up to/Date d`expiration: ……………………………………………………….
Status/Statut :
AIO Member/Membre de l`OAA
Working Language/Langue parlée:
Observer/Observateur
English/Anglais
French/Français
ACCOMPANYING PERSON’S DETAILS (IF APPLICABLE)/ACCOMPAGNE PAR
First Name/Prénom : ………………………………………. Surname/Nom : ……………………………………..Dr/Prof/Mr/Mrs/Miss
Passport No: ……………. Issued at/Delivré le: ………………Valid up to/Date d`expiration: ……………. Nationality/Nationalité:………………...
ARRIVAL AND DEPARTURE/ARRIVEE ET DEPART KAMUZU INTERNATIONAL AIRPORT
Arrival date/Date d`arrivée: …………………………….. Flight No/Vol Nº:…………………….. Time/Heure:……………………………………….
Departure date/Date de départ:……………………… Flight No/Vol Nº:……………………. Time/Heure: ………………………………………
Registration Fees/Frais D`inscription
AIO Member/Membre US$300
Observer/Observateur: US$500
Spouse/Conjoint: US$ 200
ACCOMMODATION/HERBERGEMENT: PLEASE INDICATE YOUR PREFERENCE/PRIERE D’INDIQUER VOTRE PREFERENCE
HOTEL
Sunbird Capital
ROOM TYPE
Superior
Deluxe
RATE / TAUX (US$)
130
170
Sunbird Lilongwe
Standard
109
Sogecoa Golden
Peacock
(Conference venue)
Deluxe Twin
Deluxe Suite
Deluxe Suite
100
105
480
Cross Roads
Superior Single
Deluxe Single
145
185
Pacific
Standard Single
Standard Double
Deluxe Single
Deluxe Double
101
121
121
143
Bridge View
Standard Single
Deluxe Single
Standard Double
Superior Single
Superior Double
97
80
93
77
100
Riverside
NO. OF NIGHTS/ NOMBRE DE NUITS NOMBRE DE NUITS …………………………………..
PRERERENCE
PLEASE TICK √
BENEFICIARY/BENEFICIAIRE
Insurance Association of Malawi – AIO Reinsurance Forum
National Bank of Malawi, Victoria Avenue Service Centre, Blantyre
FCD Account No. 1001341247
Bank Code: 05
Swift Code: NBMAMWMW
To be Filled and returned before 30/09/2014
A remplir et à envoyer avant le 30/09/2014
Note: The Registration form is to be completed and sent to the Conference Secretariat/A remplir et à addresser avant le 30/09/14 a` Insurance
Association of Malawi Reinsurance Forum 2014
Insurance Association of Malawi
P O Box 1021
Blantyre
Te: +265 (0) 1 831 614/ 1 835 720
Mobile: +256 (0) 999 952 277/ 999 960 401
Fax: +265 (0) 1 821 887
E-mail: [email protected]
Website: www.insurancemalawi.com
The AIO Secretariat:
P O Box 5860 Douala, Cameroon
Tel: (237) 33 42 47 58 / 33 42 01 63
Fax: (237) 33 43 20 08
E-mail: [email protected] or [email protected]
Website: www.african-insurance.org
Contact: Nellie Khoza
Contact: Stella Mojoko