ALL AFRICA CONFERENCE 2012 by 7620VY

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									                   The International Association of Lions Clubs
                        17th All AFRICA CONFERENCE
              DISTRICT 409 ( BURUNDI – R.D CONGO – RWANDA )
                           KINSHASA – R.D CONGO
                          1ST – 5th FEBRUARY 2012

                           REGISTRATION FORM
                                                                        No:____
                         PARTICIPANT INFORMATION

Title:   Mr       Mrs      Ms           Dr         Other

Last Name______________________________      Tel Office_______________________

First Name______________________________     Tel Home_______________________

Address________________________________      Tel Mobile______________________

City___________________________________      Email__________________________

Country________________________________


                             CLUB INFORMATION

Name of Lions Club_______________________________________________________

District__________________________________________________________________

Position_________________________________________________________________

Name on Badge___________________________________________________________

                           OTHER INFORMATION

Passport Number___________________    Nationality____________________________

Arrival Date_______________________   Departure Date________________________

Arrival Time_______________________ Departure Time________________________

Flight Number______________________ Flight Number________________________
 PERSONS ACCOMPANYING

Number of accompanying persons               Number attending Banquet

                               OTHER DETAILS

Vegetarian              Non Vegetarian           Other

Specify_________________________________________________________________

                             REGISTRATION FEES

Registration Fee : Before 30th November 2011 - US$200 per person

Mode of Payment: Bank Transfer           Draft        Cheque

Bank Transfer Details

Correspondent Bank Account Number   : 36908897
Correspondent Bank : CITIBANK GROUP, 399 Park Avenue, New York, Swift Code:
                     CITIUS33
Payment details      Bank             : ECOBANK RDC Sarl
                     Account Name      : LCI D409 – ALL AFRICA 2012
                     Account Number     ; 816419020117
Swift Code         : ECOCCDKI




Contact

Gerard Mulimbi      gerard.mulimbi@yahoo.com          +243 99 99 44 828

Luc Alimasi         donramy@yahoo.fr                  +243 99 99 18 043
Distinguised Lions,

Please see attached copy of the form for the 17th All Africa Conference holding in Kinshasa,
DRC in February 2012

Kindly note the following:
    Registration is $200 till Nov. 30th 2011 and $220 from Dec 1st, 2011
    Hotel deposit is $200 to be paid along with registration
    You can visit www.allafrica2012.org for further details and information on the
       conference
    Costume and Administrative charges are to be communicated as soon as possible
    Visa processing information will also be communicated but please note that visa on
       arrival in Kinshasa is $250.

We will keep you abreast of other vital information as soon as we have them.

For other info,
Call District 404A Commitee Chairperson
Lion Victoria Nya
234 803 552 1564

								
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