REGISTRATION FORM


Natural Healing
Centre, Accra,
Ghana
•
Amen Scientific
Hospital, Kumasi,
Ghana


Miracle Berries

Sphenocentrum Jollyanum

Ficus moraceae sur

Ginger

Moringa Oliefera

REGISTRATION FORM

Please fill in this form and return with appropriate non-refundable deposit as provided below to us not later than October 31, 2004. Final payment is due January 30, 2005.
Name Occupation

Work Address
Home Address
Home Phone Work Phone
Mobile Telephone

Email Address
I am a smoker I am a non-smoker I have disabilities and therefore require the following
special needs

I/We hereby enclose a non-refundable deposit in the amount checked below and authorize you to register me/us for the above conference. I/We require the following services:

Conference registration fee for an institution $700.00

Conference registration fee for an orthodox medical practitioner/legal practitioner $550.00

Conference registration fee for an indigenous healer $200.00

Conference registration fee for student $100.00

Exhibition booth hiring. Price is $350.00

The price for 7 nights hotel accommodation, meals and ground transportation on room sharing with tours is $1,560.00 per person. [This excludes transfer from Johannesburg to Cape Town]
The price for 7 nights hotel accommodation, meals and ground transportation on single room with tours is $1,950.00 per person. [This excludes transfer from Johannesburg to Cape Town]

The price for 3 nights hotel accommodation, meals and ground transportation on room sharing basis without tours is $480.00 per person.

The price for 3 nights hotel accommodation, meals and ground transportation on single room basis without tours is $718.00 per person.

Round trip New York-Atlanta/Johannesburg/Cape Town/New York-Atlanta air transfer with tours on room sharing basis. Price is $3,110.00.

Round trip New York/Johannesburg/Cape Town/New York-Atlanta air transfer with tours on single room basis. Price is $3,685.00.
Travel Insurance package (information to be provided on registration)

I/We enclose my/ourCertified Check; Money Order; authorize Africa First LLC to charge the sum of $ against my/our Visa Master Credit Card number Number Expiry date

Name on Card

Signature: _____________________________ Date:

This credit card information may be sent to an unsecured site and may be visible to others.

IMPORTANT NOTICE: Before submitting this form, all applicants must read and accept the terms and conditions set forth at the main Africa First web page, in order to participate in this and other related programs.

IMPORTANT NOTICE:

U.S. residents without credit cards can pay with certified checks and money orders.

Participants outside of the U.S. without credit cards can pay via bank transfer or international money orders.

The appropriate registration form will be furnished electronically or by mail on request for this process.

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