Registration

To register for the Fourth U.S. - Africa Business Conference please fill out the information below.

Please Note: The fields marked with an * are mandatory

Your Name
Salutation
First Name *
Middle Initial
Last Name *
Company Details
Company/ Affiliation *	(If not applicable, please write NA in the box above)
Your Title
Current Contact Information
Your Email Address *
Mailing Address *
City *
State *
Zip/Postal Code *
Country *
Work Phone *
Work Fax
Additional Information
Would you like to attend the Venture Forum Event on June 10 * (See Agenda for more details)	Yes No
Would you like to join the tours on June 10? * (See Agenda for more details	Yes No
Payment
Payment Method	Credit Card (American Express, Discover, Mastercard, Visa) Professional Development Account (WPI Faculty only)
Amount Due	$75 Registration $100 At the door.

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Last modified: Mar 31, 2008, 10:52 EDT