Registration Form

Click here to download Registration Form
compulsory fields * 
PERSONAL DETAILS:
Title  * 
Initials: * 
First Name  * 
Surname  * 
Telephone Number  * 
Fax Number
Mobile Number  * 
Email  * 
HPCSA Number  * 
Postal Address
City
Postal Code
Special meal requirements
PARTNER'S DETAILS: (for social function only)
Title
First Name
Surname
Special Dietary Requirements
Cocktail Function (7 Sep)   R 200
SASOP Congress Dinner (10 Sep)   R 400
PROFESSION:
Profession
   
 
WORKSHOP:
PRE CONGRESS WORKSHOPS (7 SEPTEMBER 10h00 - 13h00)    
     
GP Update: Psychiatry in General Practice  R   350  Not Attending
HIV/AIDS & Psychiatric Practice  R   350  
Child & Adolescent Psychiatry  R   350  
Old Age Psychiatry  R   350  
 
PRE CONGRESS WORKSHOPS (7 SEPTEMBER 14h00 - 16h00)    
     
Substance Abuse and Addiction  R    000  Not Attending
Forensic Psychiatry  R    350  
Psychotherapy in Practice  R    350  
     
 
REGISTRATION INFORMATION:  Early Registration Closed
Registration Type Early Registration
(before 31 May 2012) 		Late Registration
(from 1 June 2012)
 
Specialists
SASOP Member  R3 000.00  R3 500.00
Non SASOP Member  R3 400.00 R3 900.00
Registrars
SASOP Member  R2 200.00  R2 400.00
Non SASOP Member  R2 400.00  R2 800.00
General Practitioners & Neurologists
General Practitioners
 R3 000.00 R3 500.00
Neurologists  R3 400.00  R3 900.00
Others
(Mental health workers, nurses, psychologists, social workers)  R2 220.00  R2 500.00
Daily Registration  
   
EXHIBITORS & SPONSORS:
2 x free trade per stand
  R 0 000
Additional trade delegates  R 2 500
SOCIAL FUNCTIONS: (Please complete the following)
No charge for full congress delegates  
Cocktail function   R       0
SASOP Congress Dinner   R   350
PAYMENT:
Bank Deposit or EFT
Credit Card

   
TOTAL:
 
**Sum of 5 + 5 ?
Anti Spam
 



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