21-22 March 2016
PRE-REGISTRATION FORM
Sofitel Abidjan Hotel Ivoire
Abidjan, Côte d’Ivoire
1. PROFILE OF PARTICIPANTS The AFRICA CEO FORUM brings together company executives, investors and public officials with the following profiles: • Chair of the Board • Chief Executive Officer/President • Managing Director • Vice-President
• Partner/Associate • Minister of the Economy, Finance, and Industry • Head of Financial Institution • Presidential Economic Advisor
For corporate executives, your company’s annual turnover must exceed 10 million euros. Your registration will be confirmed upon receipt of this form and your payment, based on space availability and provided you meet the established admission criteria.
2. REGISTRATION FEES Category
Price (incl. VAT)
Quantity
Registration for ACF 2016 - registration paid by 30/10/2015*
1290 €
1
Registration for ACF 2016 - registration paid between 01/11/2015 and 31/12/2015*
1490 €
1
Registration for ACF 2016 - registration paid after 31/12/2015
1690 €
1
* To take advantage of these preferential registration fees, your application must be accepted and paid prior to the deadline indicated above.
Total
TOTAL
Benefits: Admission to the AFRICA CEO FORUM 2016 includes participation in the plenary sessions and workshops, all documentation, two buffet lunches, the Gala Dinner and coffee breaks. In case of cancellation by the participant for whatever reason, no refund will be granted by the organizer, but a hierarchically equivalent substitute delegate can be named (subject to approval by the event organizer). The request for a substitute has to be sent to the organizer as soon as possible but at the latest 20 days prior to the forum. Delegates are responsible for the arrangement and payment of their own travel and accommodation. Delegates will be able to benefit from reduced rates for hotel accommodation. Details of hotels and room rates will be sent to delegates on completion of registration and are subject to availability. After you register, you will receive a confirmation email containing payment methods and all further information about your participation in the AFRICA CEO FORUM. Registration will only be complete on receipt of full payment.
3. COMPANY Company name__________________________________________ Activity ����������������������������������������������������� If your company is part of a group, please specify the group’s name ��������������������������������������������������������� Annual turnover :
< 10 million euro
10 to 50 million euro
50 to 100 million euro
> 100 million euro
Employees:
50 to 250 people
250 to 500 people
500 to 1,000 people
> 1,000 people
< 50 people
Full address ���������������������������������������������������������������������������������������������������������� Postal (ZIP) code_________________________ City______________________________________ Country ���������������������������� Fax_____________________________________Website ���������������������������������������������������������������������
4. CONTACT details a) Personal details Title_________________First name_________________________________ Last name ��������������������������������������������� Job title_______________________________________________________ Function ���������������������������������������������� Phone_________________________________________________________ Mobile ������������������������������������������������ Email ���������������������������������������������������������������������������������������������������������������� b) Person to be contacted in your absence (assistant, associate, etc.) Title_________________First name_________________________________ Last name �������������������������������������������� Job title_______________________________________________________ Function ���������������������������������������������� Phone_________________________________________________________ Mobile ������������������������������������������������ Email ���������������������������������������������������������������������������������������������������������������� I would like to learn more about the AFRICA CEO FORUM sponsorship packages. Please send me further information. I certify that I am authorized to act on behalf of the above-named company to make this reservation. Name: Date: Signature: Validation of my registration by the organizers implies permission for them to use my image free of charge and the transfer of usage rights in all promotional material related to the AFRICA CEO FORUM.
Completed and signed form to be returned by fax to: + 33 1 44 30 18 32 or by email to register@theafricaceoforum.com