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

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* 2. Other Names

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* 3. Title

Mr

Miss

Mrs

Dr

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 $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

No

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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