Congress Registration
ALARPM membership
Congress Registration

ALARPM 6th and PAR 10th World Congress

VENUE: UNIVERSITY OF PRETORIA, GROENKLOOF CAMPUS  

PRETORIA, SOUTH AFRICA  

21 - 24 September 2003

Congress Fees ZAR Rate Before 31/05/2003 After 31/05/2003
       
Full Congress      
 Members early bird   R1400  R1800       
 Non-members early bird R1700   R2100
    Before 31/07/2003  After 31/07/2003  
 Members R1800   R2300 
 Non-members R2100  R2300
 Concessions R 700  
 FOC Invited speakers    
 Day registration R800  Which day(s)? ____________ 

                       Dinner & Night Tour:

                          National Zoological Gardens R200 per person             

Kindly complete this enrolment form and return it to CE at UP (Pty) Ltd at fax: +27 (12) 362 5285 for attention  Ronelle.  Kindly mail the original form with payment to:  CE at UP (Pty) Ltd, Private Bag X41, Hatfield, 0028.   
Payment must be received before commencement of the congress.  
APPLICANT DETAILS
Surname: Title:  Initials:
         
Preferred first name: ID no / Passport no:
                           
Organization:
   
E-mail address:
   
Address:
PO Box   Private Bag  
Street address    
Suburb  Code    
City        Code    
 
Applicant tel no:
Tel:(          )   Fax:(          ) Cell:
Dietary  requirements  ( please specify): ____________________________
Baby sitting facility for children under 5 required? Yes   (No of children) _____ No 
I enclose a cheque for the amount of ZAR ______________________ and fax you a clear copy of the deposit slip with clear indication whom it is from.
Signature: ____________________________ Date: ___________________

PAYMENT BY CREDIT CARD

Please complete payment authorisation details below
Payment to the following account:  
Account name: CE at UP (Pty) Ltd  
Bank:  ABSA Bank  
Branch: Hatfield  
Branch Code: 33-55-45
Account no: 40-5086 2993  
Type of account: Cheque account  
Street address: c/o Hilda and Burnett st., Hatfield, Pretoria  
     
Debit my:    Visa         MasterCard       
with the amount of: R                
(amount in words)  _____________________________________
 
Credit card number:  
                               
Card expiry date: 
Month     Year      
Last three digits on back of card:  
       
    Straight       Budget  Months :    
 
Cardholder details:   
Surname: _______________________ Title: __________ Initials: _______
ID/Passport number: _______________________ Tel no ______________
 
Signature: _____________________ Date: _________________________
Please fax to  Ronelle at +27 (12) 362 5285  

 

OFFICE USE ONLY

Course Number:

Course Name:

Registration no:  

Client ID:

Invoice No:

     

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