AMANA 2011 Registration

Name *

Surname *

Title / Profession

Sexe *

Masculine

Feminine

Town *

Attended church

Country *

Postal adress

E-mail *

Phone *

Fax

Status (Conference) *

Internal workers (50,000 F CFA )

Extenal workers with food (25,000 F CFA)

Internal Students (40,000 F CFA)

External students (15,000 F CFA)

External workers without food (10,000 F CFA )

External students without food (5,000 F CFA )

Observations : Give further informations about yourselves that you think we may be concerned (allergy to some food, health status, disease, …) *

AMANA Conference