1 delegate / delegue arrival / departure – arrivee / depart

Registration Form – Formulaire d’Enregistrement
15th African Reinsurance Forum / 15ème Forum de la Réassurance Africaine
Kenya, Intercontinental Hotel, Nairobi 5th – 6th October 2009 /
Kenya, Intercontinental Hotel, Nairobi 5th – 6th Octobre 2009
Please type/ print in block lettres / Utiliser caractères d’imprimerie S.V.P.
…………………………………………………………………………………………………………………………………………….
DELEGATE / DELEGUE
Surname: (Mr/Mrs/Ms)…………………………………………….….First Names………………………………………
Nom (M/Mme/Melle)………………………………………….………..Prénom :………………………………………….
Position / Fonction :……………………………………………………..
Company / Compagnie :………………………………………………..
Address / Adresse :………………………………………………………
City / Ville :………………………………………………………………….Country / Pays :……………………………….
Telephone :…………………………………FAX :………………………..E-mail : …………………………………………...
Nationality / Nationalité :……………………………………………..
Passport No.: ………………………..Issued at:……………………..Valid up to : …………………………………….
Passeport N° ……………………. Délivré le : …………………..Date d’expiration ……………………………..
Accompanied by (Surname and First Name) : …………………………………………………………………………
Accompagné par (Nom et Prénom) :………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………….
ARRIVAL / DEPARTURE – ARRIVEE / DEPART
Arrival date : …………………………….Flight N°:…………………….………Time:……………………………………
Date d’arrivée : …………………………Vol N° : ……………………………….Heure:………………………………….
Departure Date :………………………..Flight N°:…………………………….Time:……………………………..…….
Date de Départ : ……………………….Vol N°:………………………………....Heure:………………………………….
…………………………………………………………………………………………………………………………………………….
ACCOMMODATION – HEBERGEMENT
(Breakfast & taxes included / Petit déjeuner inclus)
Intercontinental Hotel (Forum venue/Lieu du Forum)
Single/Simple: US $225
Double:
US $ 270
1
• Serena Hotel *****
Single/Simple: US $ 240
Double:
US $
• The Stanley Hotel *****
Single/Simple: US $160
Double:
US $ 200
• Laico Regency Hotel ****
Single/Simple: US $ 170
Double:
US $ 200
•
Hilton Hotel ***
Single/Simple: US $166
Double:
US $ 191
Double:
US $ 150
Double:
US $ 83
Double:
US $ 122
Double:
US $ 165
• Nairobi Safari Club ***
Single/Simple: US $130
• Six Eighty Hotel ***
Single/Simple: US $59
• Heron Court Hotel ***
Single/Simple US $ 80
• Pan Afric Hotel ***
Single/Simple: US $130
280
…………………………………………………………………………………………………………………………………………….
REGISTRATION FEES PER PERSON / FRAIS D’INSCRIPTION PAR PERSONNE
: AIO Member/ Membre OAA
:$ 300
: Spouses /Epouses
:$ 100
: Observer/Observateur
:$ 500
: Local particpants Kshs 16,000 –Forms to be returned by 15th August 2009 otherwise
$ 250 apply
Rate of Exchange @13/07/09
Au 13/07/2009
1US$ = 78
1USD = 78
…………………………………………………………………………………………………………………………………………….
Registration fees are payable during registration or through Bank transfer. Copy of the transfer
to be presented at registration desk. Bank transfer fees will be supported by the participants.
Les frais d’inscription peuvent être payés à l’inscription ou par virement bancaire, une copie de
l’ordre de virement sera présentée le jour de l’inscription. Les frais de transfert bancaire seront
à la charge des participants.
BENEFICIARY / BENEFICIAIRE : KENYA RE-AFRICA REINSURANCE FORUM
Adresse : P.O.Box 30271 00100 Nairobi
BANK / BANQUE: Bank of Africa
ACCOUNT No/COMPTE N° : 01021970012
SWIFT CODE/CODE SWIFT:AFRICKENX
To be filled and returned before 30/09/2009 to KENYA RE
A remplir et à adresser avant le 30/09/2009 à KENYA RE
Tél : (+254) 20 2240188 – FAX : (+254) 20 340486 / 2252106
E-mail : [email protected] Website : www.kenyare.co.ke or www.african-insurance.org
2