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Registration for Sponsorship in R (ZAR)

Organisation name

Postal address, including city and province

Postal code

Country

Full name & surname

Email address

Work telephone

Mobile

Web adress

VAT number

Logo and web details will be placed on the conference website - 500Kb max file size

 

Select Sponsorship category

Diamond - R51 000 and more

Platinum - R31 000 - R50 000

Gold - R21 000 - R30 000

Silver - R10 000 - R20 000

Bronze - R2000 - R9000

Specify amount in ZAR (R)   

   

Fill in free delegate registration details below - Diamond, Platinum and Gold sponsor only
Registration includes accommodation and all meals from Sunday evening to Wednesday lunch but excludes flights and airport transfers - For all Halaal meals there will be a surcharge of R100 per meal (Total R900)

Title:

Prof  Dr  Mr  Mrs  Ms

First Name:

Last Name:  

Badge Name:  


Institution:

Department/School:

Special Dietary Requirements
(Halaal, kosher, Vegetarian etc.):


Email:

 

Additional free delegate registration details below -Platinum and Diamond sponsor only
Registration includes accommodation and all meals from Sunday evening to Wednesday lunch but excludes flights and airport transfers - For all Halaal meals there will be a surcharge of R100 per meal (Total R900)

Title:

Prof  Dr  Mr  Mrs  Ms

First Name:

Last Name:  

Badge Name:  


Institution:

Department/School:

Special Dietary Requirements
(Halaal, kosher, Vegetarian etc.):


Email:

   

Additional free delegate registration details below - Diamond sponsor only
Registration includes accommodation and all meals from Sunday evening to Wednesday lunch but excludes flights and airport transfers - For all Halaal meals there will be a surcharge of R100 per meal (Total R900)

Title:

Prof  Dr  Mr  Mrs  Ms

First Name:

Last Name:  

Badge Name:  


Institution:

Department/School:

Special Dietary Requirements
(Halaal, kosher, Vegetarian etc.):


Email:

   

Comments:

Payment Method

Payment is only by bank or electronic transfer

All information provided will be handled with the strictest confidence.

Note an invoice will be emailed to the email address submitted on this form