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  VASSA 2008   CONGRESS REGISTRATION FORM Click here to download the printable version.
PLEASE TAKE TIME TO COMPLETE THIS ONLINE FORM
Title:
Surname:
First Name:
Preferred Name(for name badge)
Mailing Address:
Postal Code:
HPCSA Number:
Telephone:
Telefax:
Email:
Accompanied by:
First Name
Surname
Note:
1. If you are not intending to stay at the Champagne Sport Resort, an additional charges will be made for lunches and dinners
2. Anyone wishing to attend only the Saturday and Sunday programme may do so for R950 (R1250 after 30th June 2008). These delegates will however need to make their own accommodation arrangements at a nearly hotel lodge.
REGISTRATION EARLY LATE (after 30th June 2008) Cost
Congress Fees
Participating Society Members
(Proof of membership must be provided) 		R1,900.00
R2,500.00
Non-Members R2,200.00
R3,000.00
Registration/medical Officers Technology, Nurses R1,500,00
R1,750.00
Trade Registration  
R1,000.00
TOTAL

Methods of Payment

Electronic transfer
Bank Deposit
Credit Card

PLEASE MAKE CHEQUE PAYABLE TO: RSVP Congress Account 2
Nedbank, Fourways
Account No. 1684 131 375
Branch Code: 168405

IF PAYING BY CREDIT CARD
(click here to download the credit card form)
print and fax to +27 11 463 1041

FOOD PREFERENCE
Halaal: Vegetarian: None: Other:





 
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