SASVEPM 2010 Registration
Title
:
- Select -
Miss
Mrs
Mr
Dr
Prof
Other
If other, please indicate
:
Name and Surname
*
:
Company / Institution
*
:
Postal Address
:
Telephone Number
*
:
Fax Number
:
Email Address
*
:
Dietary Requirements
:
None
Diabetic
Vegetarian
Halaal
Kosher
Other
If other, please list
:
Days Attending
*
:
18 August
19 August
20 August
All three days
Accommodation
Arrival date
*
:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
August 2010
Departure date
*
:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
August 2010
Accommodation Preference
:
None
Single R920.00 (Dinner, bed & breakfast)
Sharing R750.00 pps (Dinner, bed & breakfast)
Airport Shuttle
:
Yes
No
Flight Details
:
Arrival time & flight number:
Departure time & flight number:
Method of Payment for Accommodation
:
None
Settle Direct
EFT
Government Order
Travel Agency Voucher
Comments / Requests
:
* Compulsory Fields
