2011 IEEE Kenya Section Event Registration Form

1. REGISTRATION INFORMATION
Please complete this form, typing or printing in capitals letters. Use English __Yes, I will attend.
character and abbreviation only if more than 40 characters and spaces per line.
Photocopy for multiple registrations/participants and enclose payments (scan __No. I am unable to Signature___________
and Email the completed form to admin@ieeekenya.org) attend. __
Please PRINT your names as you want it to appear on your IEEE __Undecided.
correspondence. Date_________________
Last Name (Mr. Mrs. Ms. Dr.Eng.)____________________________________________ _
First Name: ________________________________________________________
Title: _______________________________________________________________
Method of Payment (please note that payment is
Dept: _____________________________________________________________
required with registration form) Please indicate mode of
Company/Institution: ___________________________________________________ payment
HOME ADDRESS Cheque attached – please indicate
Cheque number...………………………………………………
Address: _____________________________________________________________ Invoice - please invoice me at the below address.
Town: ____________________________________________________________
Home Phone: ___________________Fax_________________________________ Date ………………………………………………………………………..
Mobile: _________________________Home E-mail:______________________
Signature………………………………………………………………….
BUSSINESS ADDRESS .
Address: ______________________________Code_______________________
Town: __________________________________________________________ YOUR INVESTMENT:
Phone: ________________________Fax_________________________________ Seminar fee only Kshs. 38,500/=
Mobile: _______________________ Office E-mail: _______________________ Seminar fee plus 3 nights’ full board
Send all IEEE emails: Home Address Business Address accommodation Kshs 49,000/=
Cheques to be made in favour of
To better serve our
participants, your postal “Sustainable Development for All-Kenya”
mailing address is made
available to carefully selected
organisations, to provide you
Passport
TERMS AND CONDITIONS
with information on technical
services, continue education Size Photo • ACCOMMODATION: each full board participant
and conference. Your e- mail will be accommodated in an individual room at
address is not rented by IEEE. the Kenya Institute of Education and shall be
Please check box only if you fully catered for with access to all recreational
do not want to receive postal
mailing to the selected facilities at the venue
address. • Seminar fee includes tea breaks, 3-course
lunch and soft drinks
• Every participant shall be provided with
workshop training materials and a soft copy
2. 2011 Workshops & Exhibitions (CD) of all presentations and workshop
reports/deliberations.
Space at these events will be strictly limited. May we expect your
company/organization attendance? Please tick the preferred options and
number of participants. For more information on the workshops, please
check on the calendar below or visit www.ieeekenya.org Items of personal nature and bar bills not covered.
Payments must be received on or before the event.
2011 IEEE EVENTS No. of
No. participants The organizers reserve the right to refuse admission
Climate Change, Environment & where evidence of payment cannot be shown.
1. Energy Efficiency workshop
(CCEE 2011)
2. Asset Management, data security
and factory automation workshop
IMPORTANT:
3. Tele - Medicine & e - health CONFIRMATION OF
workshop
4. Engineering student’s exhibition ATTENDANCE
5. AT THIS EVENT SHOULD BE
6. DONE
7. AS SOON AS POSSIBLE TO
8. FACILITATE GOOD PLANNING &
9. COORDINATION.
10
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2011 IEEE Kenya Section Event Registration Form

IEEE GOLD Kenya

Suite 13B, Uwanja Close, off Sore road,
off Kapiti road, Plainsview, South B,
Nairobi.
P.O Box 1984-00100 Nairobi, Kenya
Tel: 020 2422516, 0721 127 876,
Email: admin@ieeekenya.org
Website: www.ieeekenya.org