Name:

Job Title:

Tel:

Fax:

Email:

Company Name:

Address:

City:

State/Province:

Zip/Postal Code:

Country:

Office Telephone Number:

(Include Country/Area/City Code):

Fax:

Emergency Contact Name:

Emergency Contact Telephone:

PRICES & PAYMENT INFORMATION

Please tick option

__ Premiere Sub Saharan Africa Oil & Gas Conference plus Gala:

     2 Day Conference Plus Gala  US $1200 

                                                            US $_______

__ Premiere Sub Sahara African Oil & Gas Conference:

     1 Day Conference Plus Gala  US $800 

                                                            US $_______

__ Premiere Sub Saharan Africa Oil & Gas Conference:

     2 Day Conference No Gala  US $1000 

                                                            US $_______

__ Premiere Sub Sahara African Oil & Gas Conference:

     1 Day Conference No Gala  US $600 

                                                            US $_______

__ Premiere Sub Saharan Africa Oil & Gas Conference Gala Only:

     Register for the Gala   US $200 

                                                            US $_______

__ Premiere Sub Sahara African Oil & Gas Conference Gala Only:

     Gala - Table for 6 persons  US $800 

                                                            US $_______

__ Corporate Leadership & Risk Management Workshop:

     1 Day Workshop Registration fee  US $300 

                                                            US $_______

DISCOUNT: Register before May 20th, 2009 and receive a 5% discount. Two or more people registering from the same organization  (Corporate Package)  before May 10th, 2009 will receive a 5% discount.

ARE YOU REGISTERED?

You will always receive an acknowledgement of your booking. If you do not receive anything please call us on 713 271 7778 or email info@energycorporateafrica.com.

Terms and Conditions

Payment is required prior to the event.

CANCELLATIONS:

To receive a refund, all cancellations must be received in writing no later than May 20, 2009. Cancellations made after May 20, 2009 will not be refunded. Send cancellation requests by email to info@energycorporateafrica.com, by fax to 1. 713 271 7773 or by mail to Energy Corporate Africa, 10103 Fondren Rd, Suite 321, Houston, Texas 77096

PRIVACY POLICY:

We do not share, rent or release your personal information to any other party. Your personal information provided to us will only be used by us for the purpose of this conference.

Yes, I  agree to the Terms and Conditions as stated on this form:

Signature:                                              

Date:

Customer Service: Tel: 713 271 7778

Email: info@energycorporateafrica.com