AHRO - International Malaria Conference

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Registration Form

Please complete the following form (this must be completed once for each delegate) then click “Submit Form Details” to process the registration.

Alternatively you may print the form, complete in BLOCK CAPITALS (once for each delegate, photocopies are valid) and return with full payment to:

Event Manager
Africa Health Research Organization
(Continental Office) PO Box NT31
Accra New Town
Ghana

All fields are compulsory.

First Name
Family Name
Designation/Professional Status
Institute/Hospital/Company
Address
City
Postal/Zip Code
Country
Email
Profession
Phone Number (Including Country and area code):
Office
Res
Mobile
Fax

Participants		Persons	Fee before 30^thMay	Fee for 30^thMay - 31^thJuly	Fee after 1^stAugust and onsite
Delegate in Dollar($)
	Full Conference		167	198	207
	Full Conference (Developing countries)		106	137	146
	Press		0	0	0
Accompanying person-Above 18 (All countries)
	All countries		50	50	50
Accompanying persons (Under 18)
	Full Conference		20	20	20
	Full Conference(Developing Countries)		10	10	10
		Total

Methods of Payment

By cheque ( Dollar only)

No:

Dated:

By Direct Bank Transfer

Name of Bank: Barclays PLC
Account Name: Africa Health Research Organization
Bank Code: 20-29-41
Account Number: 10397598
IBAN: GB87 BARC2029 410397598
SWIFT BIC: BARCGB22

By Company Payment against our invoice (In Dollar only)

By Credit Card (3.5% surcharge)

	I agree by the terms and conditions as laid out for this event

Website last modified on 12 Feb2008