Title.. Surname First Name.Middle Name.. Name of Organization:. Address.. Country... Position Held:. Mobile: Official Phone.

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1 REGISTRATION FORM NO:. 1.0 DELEGATE DETAILS Membership No:. Title.. Surname First Name.Middle Name.. Name of Organization:. Address.. Country... Position Held:. Mobile: Official Phone. Passport No: Issuing country. Expiry:. 2.0 DELEGATE REQUESTS 2.1 REGISTRATION DELEGATE ACCOMPANYING PERSON FEES EURO 900 EURO VISA PROCESSING + TRAVEL INSURANCE COST EURO 120 NAIRA 27,000 NOTE: Either pay in Euro or Naira 2.3 HOTEL S/NO HOTEL NAMES Star Rating SINGLE RATE (euro) Tick choice DOUBLE RATE (euro) Tick choice Indicative distance to congress venue (KM) 1 Relais Dei Papi Rome Garden Deile Muse Visconti Palace Regent The Duke Classic Claridge Ritz Polo Aldrovandi Villa Borghese

2 NOTE: (i) Rates include Breakfast and VAT (II) Delegates will pay additional Euro 3 per person per night as city tax Please provide the following additional information: CHECK- IN DATE.. CHECK-OUT DATE TOTAL NO OF NIGHTS. 2.4 FLIGHT ARRANGEMENT S/NO AIRLINE ECONOMY TICK CHOICE 1 British Airways 217, ,000 2 Luftansa 171, ,000 3 Turkish 165, ,000 4 KLM 179, ,000 NOTE: Airline fares are quoted in Nigerian Naira Please provide the following additional information: (I) BUSINESS TICK CHOICE Preferred Departure date.. Return date. (II) Preferred Departure Airport: LAGOS/ ABUJA (Circle as applicable) 2.5 AIRPORT TRANSFER COST EURO TOUR During the Congress (ORGANISED BY WCOA) Details will be available from January SWAN ORGANISED TOUR- After the Congress TYPE DESCRIPTION COVERAGE COST(EURO) 1 HALF DAY TOUR OF ROME 2 TOUR OF ROME WITH 4 NIGHTS IN ITALY Includes Airport transfer charges; half day tour of Rome plus 10% on Nov 13,2014; entrance fees for Vatican tour & 6 months Multiple entry Schengen visa. Excludes all meals Half day tour of Rome on Nov 13, 2014 covering Vatican Museum, Sistine Chapel, St Peter Basilica+square; including airport transfer charges plus 10% VAT; 4 nights in 3-star Hotel in Italy (Florence & Naples) including breakfast; 1 full day tour of Florence and Naples plus bus shuttle; entrance fees at Vatican, Pompeii/ Naples; 6 months Multiple entry Schengen visa. Tour 595 1,200 TICK CHOICE

3 dates from November 13 19, Excludes all meals except breakfast. 3 ROME & ATHENS (Greece) Includes returned flight tickets covering LOS-ROM-ATH-LOS (cost Euro1,120); 4 nights in 3-star hotel in Athens from Nov 15 19, 2014; daily breakfast & dinner at hotel while Lunch is enroute; 4 days daily tour of Athens & environs; airport transfer charges; bus shuttle during tour; entrance fees to tour sites; half day tour of Rome on Nov 13, 2014; 6 months Multiple entry Schengen visa 4 ROME & ANTHENS Includes returned flight tickets covering LOS-ROM-TLV-LOS (cost Euro1,120); 6 nights in 4-star hotel in Athens from Nov 15 22, 2014; daily breakfast, lunch & dinner in Israel; 6 days daily pilgrimage of Israel/ Jerusalem; airport transfer charges; bus shuttle during tour; entrance fees to tour sites; half day tour of Rome on Nov 13, 2014; 6 months Multiple entry Schengen visa 2,250 2, CANCELLATION POLICY FOR SWAN ORGANISED TOUR i. For cancellation received 3 months prior to departure, refund will be 60% ii. For cancellation received 2 months prior to departure, refund will be 40% iii. For cancellation received 1 month prior to departure, refund will be 15% iv. For cancellation received within 7days before departure, no refund will be made 5.0 SUMMARY OF PAYMENT DUE ON REQUESTED SERVICES SERVICES REQUESTED NO OF PERSONS AMOUNT DUE (EURO) Registration Fees Accompanying Person fee Visa Processing + Travel Insurance Hotel Flight Airport Transfer Tour Subtotal Before Admin Charges Admin charges 150 SUBTOTAL DUE TO ICAN SWAN Tour TOTAL PAYMENT DUE AMOUNT DUE (=N=)

4 6.0 ACCOMPANYING PERSON DETAILS Title.. Surname First Name.Middle Name.. Passport No: Issuing country. Expiry:... NOTE: if more than one (1) accompanying person, please use separate sheet to provide information and attach. 7.0 BANK DETAILS Make payment to ICAN/ WCOA Domiciliary and Naira Accounts through any of the following outlets OR The INSTITUTE s Secretariat at Victoria Island and Ebute -Meta. a. Fidelity Bank Plc Account Nos: Account No-NGN: Account No-EURO: b. Zenith Bank Plc Account Nos: Account No-NGN: Account No-EURO: c. Guaranty Trust Bank Plc Account Nos: Account No-NGN: Account No-EURO: CANCELLATION POLICY ON REGISTRATION WITH ICAN v. For cancellation received on or before 31 st July 2014, refund will be 50% vi. For cancellation received after 31 st July 2014, no refund will be made vii. All approved refunds will be processed and paid after the congress For any enquiry, please contact LAWAL ( ) and OSENI ( ) Signature Date

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