Workshop on university-industry linkages holding in Lusaka, Zambia from 12 – 14 July, 2016

REGISTRATION FORM

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* 1. Surname

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* 2. Other Names

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* 3. Title

Miss

Mrs

Prof

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* 4. Position

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* 5. Name of Institution

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* 6. Address

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* 7. City

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* 8. Country

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* 9. Telephone Number (with City Code where applicable)

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* 10. Fax Number

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* 11. Email Address

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* 12. Registration Fee:

US $700 will be paid before 30th June, 2016

US $800 will be paid on arrival

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* 13. Accommodation at Nomads Court Lodge, Lusaka

Standard Deluxe: US$ 75 / Night

Accommodation Payments should be made directly to:

BANK: Barclays Bank Zambia Plc

ACCOUNT NAME: University of Lusaka

ACCOUNT NUMBER:1071643

BRANCH CODE: 001

BRANCH: Head Office

SWIFT CODE: BARC-ZM-LX

SORT CODE: 02-00-01

Participants should emial their proof of payment to accountant@ictar.ac.zm

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* 14. Arrival Schedule

Arrival Date

Departure Date

Number of Nights

AAU BANK DETAILS

Account 1

ACCOUNT NAME: Association of African Universities

BANK NAME: Standard Chartered Bank High Street Branch Accra-Ghana

ACCOUNT NUMBER: 8700202448801

SWIFT CODE: SCBLGHAC

CORRESPONDENT BANK: Standard Chartered Bank New York

SWIFT CODE: SCBLUS33

ABA No. 026002561

Account 2

ACCOUNT NAME: Association of African Universities

BANK NAME: Zenith Bank Ghana Ltd Premier Towers Accra-Ghana

ACCOUNT NUMBER: 4050121131

SWIFT CODE: ZEBLGHAC

INTERMEDIARY BANK: Citibank New York

SWIFT CODE: CITIUS33

IBAN/FEDWIRE : FW021000089

THANK YOU