20 Dec 2023

compulsory fields * 

PLEASE NOTE: On-site registrations will be charged late registration fee + 10%
PERSONAL DETAILS:
Title  * 
First Name  * 
Surname  * 
Preferred Name
Telephone Number  * 
Fax Number
Mobile Number  * 
Email  * 
Confirm Email  * 
HPCSA Number  * 
Name of Hospital/ Company/ Organisation

(Please exclude any apostrophes in names)
Postal Address
City
Postal Code
Region / Province  * 
Food Allergies/Special Instructions?
Profession  * 

ACCOMPANYING PERSON TO SOCIAL FUNCTIONS:
Title
First Name
Surname
Food Allergies/Special Instructions?
Social Functions

REGISTRATION INFORMATION:
Registration Type Early Registration

(Before 7 May)

 Late Registration

(8 May – 9 July)

Doctor Members

R 2 300.00

  R 2 800.00
Doctor Non-Members

R 2 500.00

R 3 000.00
Nurses, Registrars & Allied Medical

R 1 500.00

R 1 800.00
Day Registration
(Excludes Social Functions)		   R 1 500.00  R 1 500.00

TRADE:
Additional Trade Members  R

1 500

PAYMENT:
Note: If registering as a group, EACH PERSON must complete a separate registration from. This booking is non-transferable, for any changes please email,

[email protected]. Only full prepaid registrations will be accepted by the organisers.

 

METHODS OF PAYMENT: Please fax through proof of payment to

+27(0)11 463 3265 or email to

[email protected]. Should this not be received, your booking will be invalid. Please select your method of payment below.

Government purchase orders:

Please note: No Government Purchase Orders will be accepted. All registrations must be prepaid.

 

Bank Deposit or EFT

Credit Card
 

TOTAL:

 
COMMENTS:
CANCELLATION POLICY:
Registration fees will be refunded less 10%

administration fee. Cancellations must be

submitted in writing no later than 15 June 2012. No cancellations will be

received after this date.

**Sum of

7 + 3

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