Fill up the pre-registration form for the the world leading high-level international meeting of African CEOs

1. 1. PROFILE of PARTICIPANTS
The AFRICA CEO FORUM is open to top company executives, investors and public officials with the following profiles:
Admission criteria: for company heads, annual turnover must be more than 10 million euro.
Confirmation of your registration will be sent on receipt of this form and payment, provided you fulfil the admission criteria.
2. BOOKING
Benefits: Admission to the AFRICA CEO FORUM 2015 includes participation in the plenary sessions and workshops, all documentation, two buffet lunches, the Gala
Dinner and coffee breaks. In case of cancellation by the participant for whatever reason, no refund will be granted by the organizer, but a hierarchically equivalent
substitute delegate can be named (subject to approval by the event organizer). The request for a substitute has to be sent to the organizer as soon as possible but at the
latest 20 days prior to the forum. Delegates are responsible for the arrangement and payment of their own travel and accommodation. Delegates will be able to benefit
from reduced rates for hotel accommodation. Details of hotels and room rates will be sent to delegates on completion of registration and are subject to availability.
After you register, you will receive a confirmation email containing payment methods and all further information about your participation in the AFRICA CEO FORUM.
Registration will only be complete on receipt of full payment.
3. COMPANY
Name___________________________________________________ Activity������������������������������������������������������
If your company is part of a group, please indicate the group’s name��������������������������������������������������������
Annual turnover: 10 million euro 10 to 50 million euro 50 to 100 million euro 100 million euro
Employees: 50 people 50 to 250 people 250 to 500 people 500 to 1,000 people 1,000 people
Full address����������������������������������������������������������������������������������������������������������
Postal code_____________________________ Town____________________________________ Country����������������������������
Fax_____________________________________ Website���������������������������������������������������������������������
4. contact details
a) Personal details
Title______________ First name________________________________ Surname��������������������������������������������������
Job title___________________________________________________ Function��������������������������������������������������
Phone_____________________________________________________ Mobile���������������������������������������������������
Email����������������������������������������������������������������������������������������������������������������
b) Contact person in your absence (assistant, colleague, …)
Title______________ First name________________________________ Surname��������������������������������������������������
Job title___________________________________________________ Function��������������������������������������������������
Phone_____________________________________________________ Mobile���������������������������������������������������
Email����������������������������������������������������������������������������������������������������������������
I am interested in learning more about the AFRICA CEO FORUM sponsorship opportunities. Please send me the full sponsorship documentation.
I confirm that I am the person authorized to sign on behalf of the above company.
Name: Date: Signature:
Validation of my registration by the organizers implies permission for them to use my image free of charge and the transfer of usage rights in all promotional material related
to the AFRICA CEO FORUM.
• Chair of the Board
• President/CEO
• Managing Director
• Vice-President
• Partner/Associate
• Minister of Economy, Finance and Industry
• Head of Financial Institution
• Presidential Economic Adviser
Category Price (incl. VAT) Quantity Total
Registration between 01/10/2014 and 31/12/2014 €1,350 1
Registration after 31/12/2014 €1,490 1
TOTAL
P R E - R E G I S T R A T I O N F O R M
Completed and signed form to be returned by fax to + 33 1 44 30 18 32 or by email to register@theafricaceoforum.com
16 -17March 2015
Intercontinental Hotel
Geneva, Switzerland