No content inserted yet Untitled Document REGISTRATION FORM A. GENERAL INFORMATION Title: Prof/Dr/Mr/Mrs/Ms Initials First Name (to be printed on the name tags) Surname Company / Institution / Department Country Telephone number Fax number Cell number Email Address: Catering - special dietary requests Regular Vegetarian Halaal Other Disability Address Do you intend to present a paper Yes No B. REGISTRATION FEES (per person) Normal Registration Cost Regular (includes conference dinner) R1400 Extra conference dinner ticket R300 No of tickets: 0 1 2 3 4 5 Student without conference dinner R600 Student with conference dinner R600 + R300 = R900 C. PAYMENT & TERMS AND CONDITIONS Direct deposit or money transfer: Fees may be deposited directly into the following bank account: Account Name: University of the Witwatersrand Bank: First National Bank Account type: Current Account Account No. : 62151059469 Branch: Corporate JHB Branch Code: 251-905 Reference: CAM/SANUM Please fax or e-mail proof of payment to sanumconference@gmail.com. (A confirmation letter and a letter of invitation if specified will be sent. Please contactus should you not receive a confirmation within five (5) working days.)
