ACISP - Africa College of Insurance & Social Protection

Application Form :

Thank you for choosing to attend INCLUSIVES AND HEALTH INSURANCE CONFERENCE FOR AFRICA. ACISP wants to make the process as easy as possible.
You will need to complete a separate registration form for each individual attending.
Denotes REQUIRED Fields.

Title :

Prof.

Dr.

Mr.

Mrs.

Ms.

Miss.

Gender :

Male

Female

Surname

First name(s)

Training Title

Start Date

End Date

Nationality

Physical Address

Mobile :

Email

Who will be responsible for Payment?

Employer

Employer and Self

Self

Company Name

Company TIN

Company VRN

Special dietary requirements:

None

Vegetarian

Halaal

Diabetic

Other

FEE STRUCTURE

Description	Mode	Fee(USD)	Fee(TZS)
Fee per person	In-Person	USD 400.00	TZS 800,000.00

Participation Fees should be deposited to:
A/c Name – AFRICA COLLEGE OF INSURANCE AND SOCIAL PROTECTION LTD
A/c No: 0250481024400(USD)
A/c No: 0150481024400(Tshs) at any CRDB branch.
All cheques should be addressed to : Africa College of Insurance and Social Protection Ltd.
Submit the original pay-in slip to ACISP Training Facility at Masaki-Oysterbay, 386 Toure Drive, No.99.