HELTASA 2015 Registration Form

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PLEASE NOTE: You will need to complete a separate form for each individual attending.

IF YOU HAVE ANY QUESTIONS ABOUT REGISTRATION, PLEASE CALL 018 299 4871.

PLEASE NOTE: You will need to complete a separate form for each individual attending. To complete the form and to submit, you are required to attach your proof of payment so please make this payment first.

BANKING DETAILS:
ABSA Takkode: 632005
Rek no: 670642313
Swift code: ABSAZAJJ

A hardcopy of this form is available for download here.

HELTASA 2015 Registration

Name and Surname *

To be used on name tag.

Title *

Choose one...

Institution *

Department/Faculty *

Email *

Cell *

Tel *

Registration *

Pre- conference workshop R550.00 (Programme not yet available)

Conference R3950.00 (incl cocktail function and HELTASA membership fees)

Gala dinner R350.00

Please note that you will be held personally responsible for full payment of conference
registration fees in the event that your company / organisation / institution do not pay.

Total *

Dietary requirements *

choose one...

Any other requirements *

(Please note that the conference will only cater for
health and religion related needs)

Proof of Payment *

Please upload your proof of payment before submitting the form. Banking details can be found below.

BANKING DETAILS:
ABSA Takkode: 632005
Rek no: 670642313
Swift code: ABSAZAJJ

IF YOU HAVE ANY QUESTIONS ABOUT REGISTRATION, PLEASE CALL 018 299 4871.

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