African Insurance Exchange

Fill your details below REGISTRATION FORM

PERSONAL DETAILS

First Name *Compulsory Fields:

Surname *Compulsory Fields:

Email *Compulsory Fields:

Gender *Compulsory Fields:

Race *Compulsory Fields: (required for reporting purposes)

Age group *Compulsory Fields:

Country *Compulsory Fields:

ID/Passport Number *Compulsory Fields:

Industry Category *Compulsory Fields:

Job Title *Compulsory Fields:

Cellphone *Compulsory Fields:

Do you require a Letter of Invitation for visa purposes? *Compulsory Fields:

Select a Membership Type to Continue *Compulsory Fields

Corporate partners

Individual members

Non-members

Early Bird

Super Early Bird

VIP/committee/speaker

TYPE OF EVENTS *Compulsory Fields

Live at Sun City

Virtual - Online

Fee (excl. VAT)

R {[reg_fess]}

OTHER FEES

Golf ({[predefinedDataSet.golf_date]})

R {[predefinedDataSet.golf_price]}

ACCOMMODATION

I'll organize my own:

Tick here if you do not want to book accommodation with us.

Please select your preferred accommodation below. Accommodation can only be booked here for the full conference period - checking in {[predefinedDataSet.check_in_date]} and checking out {[predefinedDataSet.check_out_date]}. For different periods, other requirements and different room types/hotels, please email the address at the bottom of the page after booking

Are you sharing a room with someone else?

If YES, Who is sharing your room?

Their Name and surname:

Their ID or passport number:

Accommodation:

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Arrival date:

Departure date:

DIETARY REQUIREMENTS

Please indicate your dietary requirement:

If Other, please specify:

INVOICING

Payment is due 7 days after registration (After this, outstanding registrations will be deleted)

Bank Details

Bank: First National Bank

Account Name: Insurance Institute of South Africa

Account Number: 62113428793

Branch Code: 255805

Payment Reference: Registration Reference

Swift Code: FIRNZAJJ

Address Invoice to Street Address/Post Box

City:

Postal Code:

Province:

Country:

Company/Organisation *Compulsory Fields:

Contact Name *Compulsory Fields:

VAT Number :

E-mail Invoice To:

Purchase Order Number:

IISA Membership Number: (for IISA reporting purposes)

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EXCL VAT :

R {[excl_vat]}

VAT :

R {[total_vat]}

Total Cost :

R {[total_cost]}

General Data Protection Regulation
General Data Protection Regulation & POPIA

All information is stored on our server and is handled as per our Policy Statement. We do not store credit card details or do any financial transactions on our server.

Have you read and understood the GDPR, POPIA & Refund Policy?

I understand *Compulsory Fields

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