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(if different)
VAT No: Telephone No.: *
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Delegate 1:

Title: * Job Title *
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Surname: * Email: *

Delegate 2:

Title: Job Title
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Surname: * Email:

Billing Details:

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Contact Telephone No.:
Billing Email: *
State/Province: *    
Code: *    
Country: *    

Payment Details:

For Media, Sponsor and Speaker registrations please contact carina@resources4africa.com for the relevant registration form Promo Code.
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