Delegate Registration Form

Please fill out the form below to register for the conference

NB:To ensure accurate and prompt processing of your payment confirmation, please be sure to include the following reference number in the subject line of your email:

Reference Number: # Check Accommodation : View

TITLE:

NAME:

SURNAME:

GENDER:

INSTITUTION:

POSITION:

E-MAIL:

TELEPHONE:

COUNTRY:

ORGANIZATION CURRENT STATUS:

HOTEL NAME:

DATE OF ARRIVAL:

TIME OF ARRIVAL:

ARRIVAL AIRLINE/ FLIGHT NUMBER:

DATE OF DEPARTURE:

TIME OF DEPARTURE:

DEPARTURE AIRLINE/ FLIGHT NUMBER:

Excursion (Optional)

Would you like to go for the excursion?

FOREIGN PAYMENTS – (PAYMENTS FROM OUTSIDE GHANA)
Beneficiary name: LIBERIA INSURANCE ASSOCIATION
Account Number: 00521971171450102
Name of Bank: INTERNATIONAL BANK (LIBERIA) LTD
Beneficiary Bank Address: 64 BROAD STREET MONROVIA, LIBERIA
Account No.: 10170907 (USD)
Swift Code: IBLRLRLM
Intermediary Bank Swift Code: GHIBGB2L
Bank Name: GHANA INTERNATIONAL BANK LTD LONDON
IBAN NO: GB62 GHIB 7006 1310170907

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