Registration Form: Invited participants ONLY

Kindly fill this form only if you have been invited by AGRA to register for the meeting. Return the form by 20 July 2009

Title:

Mr             Ms            Dr           Prof

Gender:

Male               Female

Surname:

Other Names:

Position/Title:

Organization:

Address:

City:

Zip/Postal Code:

Country:

Telephone1:

Telephone2:

Fax:

Cell phone:

Email address:

Title of Paper:

Name as should appear on the badge:

Travel Information: DATE OF ARRIVAL IS SUNDAY, 4 OCTOBER 2009

Arrival Date

Time

Flight No.

Departure Date

Time

Flight No.

Important: *(For only invited grantees without travel funds in their project budgets are eligible for this).

Please check this box if you need to have your air ticket bought by AGRA.

Important: Please check this box if you will NOT need hotel accommodation.

Special needs, including dietary (Please specify):

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Please Return this form by 20 July 2009 to the attention of :

Mrs. Mulemia Maina

AGRA

Eden Square, Block 1, 5^th Floor, Chiromo Road

P.O. Box 66773, Westlands 00800

Nairobi, Kenya

Email: seeds@agra-alliance.org

Tel: +254-20-3750 627/8 or 3750 632

Fax: +254-20-3750 653