| Title: |
|
|
|
| Name: |
|
|
|
| Surname / Family Name: |
|
|
|
| HPCSA No: |
|
|
|
| Organisation / Society: |
|
|
|
| Postal Address: |
|
|
|
| |
|
|
|
| Postal Code: |
|
|
|
| Province: |
|
|
|
| Country: |
|
|
|
| Email: |
|
| Confirm Email: |
|
| Telephone: |
|
|
|
| Fax: |
|
|
|
| Mobile: |
|
|
|
| |
|
|
|
| DIETARY REQUIREMENTS |
|
|
| Please indicate if you have an strict dietary requirements |
| None
Vegetarian
Halaal
Kosher |
| |
| Early Registration Cut Off Date: 31 December 2009 |
| |
| REGISTRATION TYPES |
Late Cost |
|
|
African Delegates Full (Fri, Sat, Sun) |
R1800 |
|
| African Delegates Daily |
R700 |
|
|
|
|
Overseas delegates Full (Fri, Sat, Sun) |
R3200 |
|
| Overseas delegates Daily |
R1800 |
|
|
|
|
Registrars Full (Fri, Sat, Sun) |
R1400 |
|
| |
|
|
|
| CONFERENCE EVENTS |
| Limited space is available. Bookings will be allocated on a first come first served basis. Delegates can attend both 1 morning and 1 afternoon session.
Select one morning and one afternoon session |
| 18/02/2010 |
| Name: |
Cardiology, with Prof Andrzej Okreglicki |
| Venue: |
Groote Schuur Hospital |
| Start Time: |
10:30 |
| End Time: |
12:30 |
| Cost: |
Delegates R400
/ Partners R |
| Number Attending the Cardiology, with Prof Andrzej Okreglicki |
|
Thu
|
| |
| 18/02/2010 |
| Name: |
Endocrinology, with Dr Raubenheimer and Dr Ross |
| Venue: |
Groote Schuur Hospital |
| Start Time: |
10:30 |
| End Time: |
12:30 |
| Cost: |
Delegates R400
/ Partners R |
| Number Attending the Endocrinology, with Dr Raubenheimer and Dr Ross |
|
Thu
|
| |
| 18/02/2010 |
| Name: |
Immunilogy and Allergology, with Prof Ress and Prof Potter |
| Venue: |
Groote Schuur Hospital |
| Start Time: |
10:00 |
| End Time: |
12:30 |
| Cost: |
Delegates R400
/ Partners R |
| Number Attending the Immunilogy and Allergology, with Prof Ress and Prof Potter |
|
Thu
|
| |
| 18/02/2010 |
| Name: |
Sports Medicine, with Prof Tim Noakes |
| Venue: |
Groote Schuur Hospital |
| Start Time: |
10:30 |
| End Time: |
12:30 |
| Cost: |
Delegates R400
/ Partners R |
| Number Attending the Sports Medicine, with Prof Tim Noakes |
|
Thu
|
| |
| 18/02/2010 |
| Name: |
Infectious Diseases, with Prof Mendelson |
| Venue: |
Groote Schuur Hospital |
| Start Time: |
13:30 |
| End Time: |
15:30 |
| Cost: |
Delegates R400
/ Partners R |
| Number Attending the Infectious Diseases, with Prof Mendelson |
|
Thu
|
| |
| 18/02/2010 |
| Name: |
Respiratory, with Prof Bateman |
| Venue: |
Groote Schuur Hospital |
| Start Time: |
13:30 |
| End Time: |
15:30 |
| Cost: |
Delegates R400
/ Partners R |
| Number Attending the Respiratory, with Prof Bateman |
|
Thu
|
| |
| 18/02/2010 |
| Name: |
Neurology, with Prof Eastman |
| Venue: |
Groote Schuur Hospital |
| Start Time: |
13:30 |
| End Time: |
15:30 |
| Cost: |
Delegates R400
/ Partners R |
| Number Attending the Neurology, with Prof Eastman |
|
Thu
|
| |
| 18/02/2010 |
| Name: |
Rheumatology, with Prof Kalla |
| Venue: |
Groote Schuur Hospital |
| Start Time: |
13:30 |
| End Time: |
15:30 |
| Cost: |
Delegates R400
/ Partners R |
| Number Attending the Rheumatology, with Prof Kalla |
|
Thu
|
| |
| 18/02/2010 |
| Name: |
Department of Medicine: 90th Anniversary lectures |
| Venue: |
Lecture Theatre 2, New Grooet Schuur Hospital |
| Start Time: |
16:00 |
| End Time: |
18:00 |
| Cost: |
Delegates R0
/ Partners R |
| Number Attending the Department of Medicine: 90th Anniversary lectures |
|
Thu
|
| |
| 18/02/2010 |
| Name: |
90th Anniversary/Conference Dinner |
| Venue: |
Jameson Hall, University of Cape Town |
| Start Time: |
19:00 |
| Cost: |
Delegates R250
/ Partners R250 |
| Number Attending the 90th Anniversary/Conference Dinner |
|
Thu
|
| |
| PAYMENT INFORMATION: |
|
|
Cancellations
Cancellations should be mailed, faxed or e-mailed to Jolandi Ackermann at the address below. A cancellation fee of 10% applies before 01 February 2009, thereafter a 100% cancellation fee applies. |
| |
|
|
|
| Local Delegates |
|
|
|
- Bank deposits (preferred method of payment): Please see banking details below and fax a legible deposit slip to +27 21 448 6263.
- Electronic transfers: Please see banking details below and fax a legible deposit slip to +27 21 448 6263.
- Cheques: Please see account name and address below under "Banking Details".
- Credit cards: Please print the authorisation form, complete in full and return according to the directions provided.
|
| Overseas Delegates |
|
|
|
- Electronic transfers: Please see banking details below and fax a legible deposit slip to +27 21 448 6263.
- Credit cards: Please print the authorisation form, complete in full and return according to the directions provided.
- Tele-transmissions (preferred method of payment): Please see banking details below, quote our Swift code (SBZAZAJJ) and e-mail or fax proof of payment to +27 21 448 6263.
|
| |
|
|
|
| BANK DETAILS: |
|
|
|
| Bank: |
Standard Bank |
| Branch: |
Mowbray Branch |
| Branch Code: |
02-49-09 |
| Account Name: |
Conference Management 11 |
| Account Number: |
071272364 |
| |
|
|
|
| AIRPORT TRANSFERS AND TOURS |
|
|
For information or to book an airport transfer please contact:
Mpumalanga Tours, Robin Troup
Tel. +27 (0) 82 657 3443
Email: wildsafari@worldonline.co.za |
| |
| FURTHER INFORMATION AND ENQUIRIES: |
| |
Jolandi
Ackermann |
| Tel: +27 21 406 6381 |
| Fax: +27 21 448 6263 |
| Email: Jolandi.Ackermann@uct.ac.za |
|
|
|
|
