Conference Registration Form s2

CONFERENCE REGISTRATION FORM

COMPANY DETAILS Name of Organization/ Individual Sector and Email address ID/ Passport Number (For Individuals) Building …………………………………Street & Physical Address Floor………………………………...

Postal address& Code

Telephone Numbers Landline Mobile Name & Email Address of the Director/ Manager Name & Email Address of HR Director/Manager

Date Conference Name

Your organization Pin No PLEASE PROVIDE NAMES OF YOUR STAFF YOU ARE NOMINATING TO ATTEND THE CONFERENCE Name Title/ Position Email Mobile No

PAYMENT DETAILS In favour of the Kenya School of Revenue Administration Account No: 01023015000900 PAY VIA MPESA Branch: Times Tower Branch Lipa na Mpesa Account Name: Kenya school of Revenue Administration Paybill No: 833613 Account Name: 2ND ESA- ID/PASSPORT NO NB: Indicate the name of the organisation and the course on the deposit slips. Name of Authorizing Manager Signature and Date

Cheque No Amount

REGISTRATION AND BOOKING

CONTACT: Caroline, Anwar, Techlar or Melvin KESRA NAIROBI: Times Tower -8th Floor Tel: 0709752727/ 020 2814153/0709013161/0715877535/0715877539 Email : kesra [email protected]

Disclaimer; please note that the deadline of registration and payment is 3rd November 2016