CNIC Registration Form

Page 1

REGISTRATION

*Nigerian Naira prices below are based on the current exchange/market rates, and are subject to change

Personal Information First Name: Last Name: Company: Job Title: Address: Postal Code: City: Province: Country: Telephone: E-mail: MEMBER

NON-MEMBER FEE

Registration

$250 + HST and 2.75% service fees (Total $291.88) (Total N 45,442.21)

$300 + HST and 2.75% service fee (Total $350.25) (Total N 54,529.72)

Business class

$400 + HST and 2.75% service fees (Total $467) (Total N 81,795.36)

$450 + HST and 2.75% service fee (Total $525.38) (Total N 99,971.94)

Table (6 Registations included)

$1,100 + HST and 2.75% service fees (Total $1,284) (Total N 199,903.39)

$1,425 + HST and 2.75% service fee (Total $ 1,663.69) (Total N 259,016.57)

Table (6 Business Registations included)

$1,800 + HST and 2.75% service fees (Total $2,101.50) (Total N 327,178.33)

$2,500 + HST and 2.75% service fee (Total $ 2,918.75) (Total N 454,414.35)

Kiosk Booth

$2,750 + HST and 2.75% service fees (Total $3,210.63) (Total N 499,856.56)

$3,300 + HST and 2.75% service fee (Total $3,852.75) (Total N 599,826.94)

(access to the VIP Breakfast & Lounge)

(Includes Two Registration)

NIGERIAN DELEGATION FEE SINGLE DAY REGISTRATIONS (Do not select if you have chose one of the above packages)

$200 + HST and 2.5% service fees (Total $233.50) ( Total N 36,353.15) 1-Day Conference Thursday or Friday (cannot be combined) Reception and Gala Dinner

$175 + HST and 2.75% service fees (Total $204.31) (Total N 31,571.16) $125 + HST and 2.75% service fees (Total $145.94) (Total N 22,551.38)

Payment Option SubTotal: HST: Total: Cacellation Policy

Payment - Cheque Credit Card: Visa Credit Card Number: Expiry Date:

If unable to attend, a designated person is welcome at no extra charge with prior notifications. CCAfrica does not refund for cancellations. CCAfrica will make available information documentation to any registrants who’s unable to attend. CCAfrica has the right to change the programme of the conference without notice including the speakers, topics or date of the event.

Mastercard

Signature: Send by Fax (613)565-3013 or by E-mail to chris.kianza@ccafrica.ca For more information contact Chris Kianza, Vice President (613)565-3011

For More Information Please Contact:

Chris Kianza, Vice President, Business Development and Member Relations Phone: (613) 565-3011, Email: chris.kianza@ccafrica.ca

SUBMIT


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