AFRICAN ROAD SAFETY CONFERENCE 57 FEBRUARY 2007 ACCRA GHANA

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4TH AFRICAN ROAD SAFETY CONGRESS

AFRICAN ROAD SAFETY CONFERENCE

5-7 February 2007

Accra, Ghana


Registration form

(Please print or type)


Title (Dr / Ms / Mr / Prof) __________________________


Sex (M/F) ______


First name: _________________ Middle initial: __________


Family name: _________________________


Nationality: __________________________


Affiliation (Organization): __________________________


Department / Division (if applicable) ________________


Position: _______________________________________


Address: _______________________________________


City: ___________________________________________


Country: ______________________________


Tel: (including country and area codes) ___________________


Fax: _________________________


Email: __________________________________



Areas of expertise / interest (please check all that apply to a maximum of 4)


□ Road safety policy

□ Road safety legislation

□ Infrastructure safety

□ Road safety law enforcement

□ Road safety education

□ Vulnerable road users

□ Road safety economics and financing

□ Vehicle design

□ Road safety advocacy

□ Research (specify field) _______________________

□Other ­­­­­­­­­­­­________________________


How are you paying for your participation at the Congress?

□ Personal resources

□ Sponsored by my organization / government

□ I have a grant from sources other than my organization / government

□ I have no confirmed funding but hope to raise it by the time of the conference


Have you attended any of the three previous African Road Safety Congresses?

□Yes □ No □ Don’t remember


How did you hear about the Congress?

□ Invitation letter

□ Information from colleagues

□ Internet search

□ Other (specify) _____________________________


Would you like to book your accommodation through the conference organizers?

□Yes □ No □ Undecided








Application for registration fee waiver:


A very small number of scholarships are available only for conference registration fees. No scholarships are available for travel or accommodation. If you wish to apply for a waiver, please indicate below. These waivers will be given on a first-come-first-served basis, and giving priority to those who already have funding to cover their other expenses.


Are you applying for a waiver? Yes / No



Please see note on application for congress registration fee waiver


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