Nigerian Insurers Association

AIO LIFE SEMINAR

10^th - 13^th November, 2010 Lagos, Nigeria

REGISTRATION FORM/FORMULAIRE D’ENREGISTREMENT

(Please type or print in block letters and complete one form per delegate)
(Veillez SVP completer en letteres majuscules un formulaire par delegue)

Title (Dr./Mr./Mrs./Ms.):

Surname/Nom :

First Name/Prenoms :

Nationality/Nationalite :

Passport Number/No. de Passeport. :

Passport Expiry Date/Date d'expiration :

Company/Organization/Nom de la Societe ou Institution:

Position/Title/Fonction :

E-mail :

City/Localite :

Country/Pays :

Telephone :

Fax :

Next of Kin/Proche Parent :

Tick as Appropriate:

Delegate

AIO Member/Membre :

Observer/Observer :

Languages Spoken

English :

French :

Accompanying spouse details (If applicable) :

Spouse Info

Surname/Nom:

First Name/Prenoms:

Flight Details/Details De Vol :

Arrival Date/Date d'arrivee:	Flight Number/No. de vol:	Arrival Time/Heure:
Departure Date/Date de retour:	Flight Number/No. de vol:	Departure Time/Heure:

Accomodation Options/Hebergement :

Hotel: - Special negotiated rates for the AIO conference. Daily rates (USD$) for Bed & Breakfast - Tarif special pour les Conferenciers, tarif Jour Compris Le Petit Dejeuner*
Check-in Date/De' entrée:	Check-out Date/Date sortie:
*Eko Hotel & Suites, Lagos, Nigeria is the venue of the Seminar

Excursion:

Are you interested in the Excursion?/Etes-Vous Interesee Par L’Excursion: Yes/Oui No/Non

Tourism Destination: Guided Tour of Lagos

Excursion Fee: US$30

REGISTRATION FEES PER PERSON/FRAIS D'INSCRIPTION

AIO Registration