REGISTRATION PAGE Infrastructure Africa 2017 – Attendee Registration To register to attend the conference, please fill out the form below: 2 day Infrastructure Africa Conference: 21 – 22 August 2017. Fee: R8,250.00 exl VAT (USD 600)* (*Required) Delegate Details: Title (*Required) ---MrMrsDrProf First Name (*Required)Please leave this field empty. Last Name (*Required) Job Title / Position (*Required) Organisation name (*Required) VAT Registration Number Invoicing Address: City State Postal Code Country ---AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepChadChileChinaColombiaComorosCongoCongo {Democratic Rep}Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIreland {Republic}IsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar, {Burma}NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe Phone (*Required) Fax Mobile Email (*Required) Authorising Manager Date I agree to the full terms and conditions Payment Details Payment is due in 7 days of invoice/registration received. If you reserve your ticket but pay by invoice or bank transfer, payment must be received in 7 days. Please quote IA invoice number or IA and the delegate’s name when paying by Bank Transfer. Contact person for invoicing Organisation purchase order number (if applicable) Special endorsing partner code (If applicable) How did you hear about the event? (*Required) Marketing emailAdvertisement (billboard, print, radio)Consultant (Please choose consultant from list below) No consultantMariaMbachi ALTERNATIVE WAYS TO REGISTER: Tel: +27 11 463 9184 Fax: +27 11 463 8432 Cell: +27 71 844 2569 Online: www.infrastructure-africa.com Group Bookings Why not send your team and save more? Contact us today to explore the special offers available. Location Sandton Convention Centre 161 Maude Street Sandton, Johannesburg, South Africa TERMS AND CONDITIONS Participation fee includes access to the appropriate session presentations and networking opportunities, refreshments, lunch and post conference proceedings. (The fee excludes travel and accommodation costs) Payment of full delegate fee is due within 7 days of receipt of invoice, or immediately with registration if the booking is made within 2 weeks of the event. Siyenza reserves the right to refuse entry to the event should payment not be received prior to the event. Should you be unable to attend, a substitute delegate is welcome at no extra charge. Siyenza reserves the right to alter the programme without notice including the substitution, alternation or cancellation of speakers and/or topics and/or the dates of the event. Siyenza is not liable for any loss or damage as a result of a substitution, alternation, postponement or cancellation of the event. A complimentary ticket cannot be used by a person already registered for the event, no refund can be given respectively. Cancellation policy: 50% refunded only if written notice is received 21 days before the event: 25% refunded of written notice is received 14 days before the event. Registrants that do not attend the event after the cancellation date will be liable for 100% payment of the invoiced amount. PRIVACY POLICY Siyenza may contact you about products and services offered by Siyenza and its projects, which may be of interest to you. Please tick the below box if you do not wish to receive information from or your information disclosed to: Siyenza ProjectsReputable third parties What is 10 + 10 (*Required)
