SPONSORSHIP FORM – 2nd ADIafrica International Summit

1. Title:
Prof.Dr.Mr.Mrs.Ms.

2. Last Name (required):

3. First Name (required):

4. Address For Correspondence (required):

5. Country (required):

6. Institution/Company (required)

7. Telephone(required):

8. Fax:

9. E-mail Address (required):

10. Website:

11. CHECK ALL THAT APPLY. I want to be a : Silver Sponsor (500 €)Gold Sponsor (1500 €)
In return I will receive the stand, the conference ticket and the publicity that is mentioned in the sponsorship and exhibitor’s brochure.

12. Input the total amount (in Euros or equivalent) you will be paying or have paid. Please specify the correct currency:

13. Upload your Proof of Payment. Maximum Size 2MB.

Make payment into the bank account information provided on this page.

By submitting this form, I have read and agreed to the Exhibitor's Terms and Conditions.