University-Industry Linkages for African Universities | 6 – 8 Feb, 2018 | Ghion Hotel, Addis Ababa

Workshop Registration fee of US $500 covers group lunch and conference materials

Title/Titre

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* 1. Title/Titre

Surname/Nom

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* 2. Surname/Nom

Other Names/Prénoms

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* 3. Other Names/Prénoms

Gender/Sexe

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* 4. Gender/Sexe

Position/Poste

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* 5. Position/Poste

Name of Institution/Non de l’Institution

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* 6. Name of Institution/Non de l’Institution

Address/Adresse

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* 7. Address/Adresse

City/Ville

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* 8. City/Ville

Country/Pays

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* 9. Country/Pays

Telephone Number (with City Code where applicable)/No. de tel. (avec le préfixe s’il y lieu)

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* 10. Telephone Number (with City Code where applicable)/No. de tel. (avec le préfixe s’il y lieu)

Email Address/Adresse email

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* 11. Email Address/Adresse email

Registration fees should be paid in full by transferring the registration fee to the AAU’s bank account no / Les frais d'inscription doivent être payés intégralement par transfert au compte bancaire de l'AUA:

Account Name: ASSOCIATION OF AFRICAN UNIVERSITIES
Name of Bank: STANDARD CHARTERED BANK
HIGH STREET BRANCH
ACCRA-GHANA
Account Number: 87002-024488-01
Swift Code: SCBLGHAC
US Correspondent bank: SCB New York
Swift Code: SCBLUS33
ABA#: 026002561
How did you get to know of these workshops? (Select more than one avenue if it applies in your case) / Comment avez-vous eu connaissance de ces ateliers? (Sélectionnez plus d'une voie, le cas échéant)

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* 12. How did you get to know of these workshops? (Select more than one avenue if it applies in your case) / Comment avez-vous eu connaissance de ces ateliers? (Sélectionnez plus d'une voie, le cas échéant)

THANK YOU | MERCI

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