REGISTER

IMPORTANT NOTE: All items marked * as they are compulsory.

DELEGATE DETAILS:
Surname:
Name:
Title:	Please select Mr Mrs Ms Dr Prof other
If title other, please specify:
Preferred name for name badge:
Telephone:
Fax:
Email:	(E-mail)
Organisation:
Designation:
PARTNER DETAILS, IF APPLICABLE:
Partner surname:
Partner name:
Partner title:	Please select Mr Mrs Ms Dr Prof other
If partner title is other, please specify:
Partner's preferred name:
Partner cocktails party attendance:	Please select Yes No
SPECIAL NEEDS:
Diet:	Please select Vegetarian Halaal Kosher other
If diet is other, please specify:
Diet - number of people:
Registration fees:	Please select the registration category Standard Rate ZAR R3495.00 Speakers’ fee ZAR R2995.00
I agree to conditions of registration:	Click here to read conditions of registration
Date:	8/1/10 5:01:11 A
Security:	Type the characters you see in the picture below.