Training Workshop on University-Industry Linkages in Voila Bagatelle Hotel, Mauritius on the 11th to 13th April, 2017

REGISTRATION FORM

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1. Surname (Required.)

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2. Other Names (Required.)

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3. Title (Required.)

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) (Required.)

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10. Fax Number

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11. Email Address (Required.)

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12. Registration Fee: (Required.)

US $600 will be paid before 15th March, 2017

US $700 will be paid on arrival in Mauritus

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13. Will you need assistance with transport?

Yes

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14. Accommodation at Voila Bagatelle Hotel, Mauritius

Single Bed: US $105

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15. Arrival Schedule

Arrival Date

Departure Date

Number of Nights

THANK YOU

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* 1. Surname (Required.)

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* 2. Other Names (Required.)

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* 3. Title (Required.)

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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) (Required.)

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* 10. Fax Number

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* 11. Email Address (Required.)

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* 12. Registration Fee: (Required.)

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* 13. Will you need assistance with transport?

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* 14. Accommodation at Voila Bagatelle Hotel, Mauritius

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* 15. Arrival Schedule

1. Surname (Required.)

2. Other Names (Required.)

3. Title (Required.)

4. Position

5. Name of Institution

6. Address

7. City

8. Country

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

10. Fax Number

11. Email Address (Required.)

12. Registration Fee: (Required.)

13. Will you need assistance with transport?

14. Accommodation at Voila Bagatelle Hotel, Mauritius

15. Arrival Schedule