Documente Academic
Documente Profesional
Documente Cultură
Please complete and return by e-mail, regular mail or fax (details and address below). Please
note that registrations not accompanied by payment will not be honoured (the rate payable
is the rate at date of received payment not the date of mailing).
(Please note that the name and title you give here will be printed on your badge and on the
participants’ list).
1. Participant's information
Family name:_________________________________________________________
First name:___________________________________________________________
Organisation:__________________________________________________________
Address:______________________________________________________________
Country:______________________________________________________________
Telephone:____________________________________________________________
Fax:_____________________________
E-mail:___________________________
'EARLY BIRD' 'Africa' rate - 'Africa' rate - non- All other domiciles
by October 30 Student*+ student+
25 Euro 75 Euro 300 Euro (GBP 250)
Standard 'Africa' rate - 'Africa' rate - non- All other domiciles
Registration (from Student*+ student+
November 1)
50 Euro 100 Euro 350 Euro (GBP 300)
*Please include a copy of your valid student card if requesting a student rate.
+Please note that only participants with a permanent home and work/study address in Africa
qualify for this rate.
3. Payment
All cash and cheque payments into this account should therefore be made at the UB cash
office into account WS61-5402. All payment from outside the country should be paid by
telegraphic transfer(TT) into the UB bank account:
- by credit or debit card, by mail, fax or e-mail (complete the details below and
send to the appropriate form of address above)
Card Number
Start date Expiry date Security Number Issue Number (where appropriate)
Date: _________/________/2010
Signature:_______________________________________