African Conference on Edible Insects 14-16 August 2019 African Conference on Edible Insects Registration Form We thank you for your interest in participating at our conference. Fill in our Conference Registration Form below to receive your badge number and the schedule of the entire event. Return the form and attach proof of payment to: [email protected] Name of Attendee…………………………………………………………………………….. Organization/Company………………………………………………………………………. Address………………………………………………………………………………………… ………………………………………………………………………………………………….. …………………………………………………………………………………………………... ……………………………………………………………………………………...................... Email…………………………………………………………………………………………… Phone number…………………………………………………………………………………. Type of Registration (Please tick the appropriate) Student Regular Exhibitor Do you require accommodation? Yes No Payment/ Banking Details Bank Name: First Banking Corporation Account name: Chinhoyi University of Technology Account number: 1140042840350 Bank Address: 5309 Magamba Way, Chinhoyi Telephone number: +263 67 24086/ +263 67 25308 Branch code: 8511 Swiﬅ Code: FBCPZWHA (attach current student ID)

African Conference on Edible Insects Registration Form · 2019-06-03 · African Conference on Edible Insects Agst 2019 African Conference on Edible Insects Registration Form We thank

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African Conference on Edible Insects 14-16 August 2019

African Conference on Edible Insects Registration Form

We thank you for your interest in participating at our conference. Fill in our Conference Registration Form below to receive your badge number and the schedule of the entire event. Return the form and attach proof of payment to: [email protected]

Name of Attendee……………………………………………………………………………..

Organization/Company……………………………………………………………………….

Address……………………………………………………………………………………………………………………………………………………………………………………………..…………………………………………………………………………………………………...……………………………………………………………………………………......................Email……………………………………………………………………………………………

Phone number………………………………………………………………………………….

Type of Registration (Please tick the appropriate)

Student

Regular

Exhibitor

Do you require accommodation?

Yes

Payment/ Banking DetailsBank Name: First Banking Corporation

Account name: Chinhoyi University of TechnologyAccount number: 1140042840350

Bank Address: 5309 Magamba Way, ChinhoyiTelephone number: +263 67 24086/ +263 67 25308

Branch code: 8511Swift Code: FBCPZWHA

(attach current student ID)

Page 2: African Conference on Edible Insects Registration Form · 2019-06-03 · African Conference on Edible Insects Agst 2019 African Conference on Edible Insects Registration Form We thank

African Conference on Edible Insects 2019

Do you wish to attend the conference dinner on 14 August 2019?

Yes

Do you have any dietary special requirements?

Yes

If yes, Please specify

………………………………………………………………………………………………………................

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