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

CONFERENCE PARTICIPATION FEES

- ONLINE ATTENDANCE (VIRTUAL) - USD50 OR 120,000TZS
- PHYSICAL ATTENDANCE - USD150 OR 350,000TZS
Participation Fees should be deposited to:

(FOR TANZANIAN SHILLINGS DEPOSITS)
A/c Name – AFRICA COLLEGE OF INSURANCE AND SOCIAL PROTECTION LTD
A/c No: 0150481024400 at any CRDB branch.

(FOR US DOLLARS DEPOSITS)
A/c Name – AFRICA COLLEGE OF INSURANCE AND SOCIAL PROTECTION LTD
A/c No: 0250481024400 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.