Environmin 2011 Registration Form
Title :
Name:
Surname :
Institution
Represented :
Tel no :
Fax no :
E-mail :
Student?
Yes
No
If yes, please specify :
Full Time
Part Time
Student Number :
University of study :
Degree registered for :
Accommodation
Arrival Date
Departure Date
Room type :
Single Room
R839.00 per night (Dinner, bed & breakfast)
Twin Room
(2 beds per room)
R709.00 per person sharing per night (Dinner, bed & breakfast)
Cabins (Sleeping 5 people
)
R573-00 per person sharing per night (Dinner, bed & breakfast)
Do you require airport shuttle?
Yes
No
If yes, please specify your flight details:
Flight Number :
Arrival Date & Time
Date:
Time:
Departure Date & Time
Date:
Time:
Do you have special dietary requirements?
Yes
No
If yes, please specify :
Dietry Requirement :
