THE DRUM CAFÉ 2010 PEACE ARTS FESTIVAL/CONFERENCE
P.O.BOX 43031-00100 NAIROBI, KENYA , TEL: +254(0)208078213, +254(0)720204271, E-MAIL:drumcafe2010@gmail.com
WEBSITE: http://thedrumcafe.viviti.com/
Registration Form
PERSONAL INFORMATION
Title
Preferred Name on Tag
First Name*
Last Name*
Email* Gender
Phone Number Mobile Phone
City
Postal Address
Zip Code
State
Country
Organization*
Date of Birth
Passport Number
Passport Expiration Date
Special Needs
Your Citizenship
PAYMENT INFORMATION
Payment Mode
Bank Wire
Cheque
Western Union Money Transfer
Amount
Contact Person (in case of emergency)
Full Name:
Relationship to you:
Email:
Phone:
DEAD LINE FOR SENDING IN FORMS IS 18 AUGUST 2010
P.O.BOX 43031-00100 NAIROBI, KENYA , TEL: +254(0)208078213, +254(0)720204271, E-MAIL:drumcafe2010@gmail.com
WEBSITE: http://thedrumcafe.viviti.com/
Registration Form
PERSONAL INFORMATION
Title
Preferred Name on Tag
First Name*
Last Name*
Email* Gender
Phone Number Mobile Phone
City
Postal Address
Zip Code
State
Country
Organization*
Date of Birth
Passport Number
Passport Expiration Date
Special Needs
Your Citizenship
PAYMENT INFORMATION
Payment Mode
Bank Wire
Cheque
Western Union Money Transfer
Amount
Contact Person (in case of emergency)
Full Name:
Relationship to you:
Email:
Phone:
DEAD LINE FOR SENDING IN FORMS IS 18 AUGUST 2010
