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 Registration

INTERNATIONAL ANXIETY DISORDERS SYMPOSIUM
SOUTH AFRICA
1-2 MAY 2010

Registration Form
Spier Estate, Stellenbosch, Western Cape
www.sasop.co.za


PARTICIPANT DETAILS
 
Title:
Surname: *
First Name: *
HPCSA no:
Telephone Number: *
Fax Number:
Cell Number: *
Email: *
Physical Address (W):
 
City:
Country:
Code:
Special Meal Requirements:
Other

ACCOMPANYING PERSON (PARTNER / SPOUSE)
 
Title:
Surname:
First Name:
   

CONFERENCE REGISTRATION FEES EARLY
(Before 15/02/10) 		LATE
(Before 16/04/10)

Specialists (Local)
ZAR 1 650.00
ZAR 2 200.00
Specialists (International) ZAR 2 200.00 ZAR 2 750.00
Day Registration Fee (Local) ZAR 1 000.00 ZAR 1 300.00
 
Day Registration Fee (International) ZAR 1 300.00 ZAR 1 500.00
 
Registrar / Student Fee ZAR 1 200.00 ZAR 1 400.00
Trade ( 2 Free registrations per stand) ZAR 1 000.00 ZAR 1 000.00
Partner / Spouse Fee (For Cocktail function only) ZAR    300.00 ZAR    400.00
     
Delegate attending Cocktail Function Yes   No  

Total

PAYMENT DETAILS
 
EFT
Credit card   ( MASTER & VISA cards only )
  

Please fax proof of payment to Londocor Public Relations & Event Management on (+27) 11 768 1174

CANCELLATION POLICY
 
Neither the Organising Committe nor Londocor will be held responsible for the cancellation of registration. Written notice of cancellation must be received by the congress organiser via email, fax of letter no later than 02 April 2010 and a R350 administration fee will be payable. No refunds of registration fees will be made after this date. Website: www.sasop.co.za