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:

HOTEL ROOM TYPE:

DATE OF ARRIVAL:

DATE OF DEPARTURE:

TIME OF DEPARTURE:

TIME OF ARRIVAL:

AIRLINE:

FOREIGN PAYMENTS – (PAYMENTS FROM OUTSIDE GHANA)
Account Name: West African Insurance Companies Association
Account Number: 2441001140913
Swift Code: ECOCGHAC
Name of Bank: Ecobank Ghana
Bank Branch: Head Office
Address: 19 Seventh Avenue, Ridge West
P.O. Box AN 16746
Accra- North
Ghana

ACCESS BANK DETAILS – SIERRA LEONE
Account Name: Sierra Leone Insurance
Beneficiary Address: 34 Percival Street
Account Number: 0100100050200 (Leones)
BBAN: 00907701100050200-13 (B-Ban)
Account Currency: Sierra Leone, Leones and Cents
Swift Code: ABSFSLFRXXX
Bank Name: Access Bank SL Limited
Bank Address: 30 Siaka Stevens Street, Freetown
Intermediary Bank: Citi Bank New York, U.S.
Intermediary Swift Code: CITIUS33
Intermediary Account Number: 36439963
Routing Number: 021000089

LOCAL PAYMENTS – (PAYMENTS WITHIN GHANA)
Account Name: West African Insurance Companies Association
Account Number: 3441001140914
Swift Code: ECOCGHAC
Name of Bank: Ecobank Ghana
Bank Branch: Head Office
Address: 19 Seventh Avenue, Ridge West
P.O. Box AN 16746
Accra- North
Ghana

NB: Please note that all delegates are to make provisions for payment of Airport tax of a total of $50 and Ferry Charges of $90

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