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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:
3/9/10 6:14:43 P
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