<p> CONFERENCE REGISTRATION FORM</p><p>COMPANY DETAILS Name of Organization/ Individual Sector and Email address ID/ Passport Number (For Individuals) Building …………………………………Street & Physical Address Floor………………………………...</p><p>Postal address& Code </p><p>Telephone Numbers Landline Mobile Name & Email Address of the Director/ Manager Name & Email Address of HR Director/Manager</p><p>Date Conference Name</p><p>Your organization Pin No PLEASE PROVIDE NAMES OF YOUR STAFF YOU ARE NOMINATING TO ATTEND THE CONFERENCE Name Title/ Position Email Mobile No </p><p>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</p><p>Cheque No Amount </p><p>REGISTRATION AND BOOKING </p><p>CONTACT: Caroline, Anwar, Techlar or Melvin KESRA NAIROBI: Times Tower -8th Floor Tel: 0709752727/ 020 2814153/0709013161/0715877535/0715877539 Email : kesra [email protected] </p><p>Disclaimer; please note that the deadline of registration and payment is 3rd November 2016</p>