SASCRO SASMO 2017 Congress
CoBrCa

Online Registration

Please use mixed-case lettering.

Please ensure that that you receive a confirmation by e-mail from the organisers within 10 working days.

FAX / E-MAIL proof of payment to + 27 (0) 86 60 60 555 / info@rkcommunication.co.za BEFORE 17 May 2017.

Important request to companies sponsoring delegates:
Kindly let us have the delegate’s personal postal address and other contact information.

 

Personal Details
Title
 
Initials
 
Surname
 
First Name
 
Preferred Badge Name
 
Occupation
Specify
HPCSA Number
Company / Institution
VAT Number
Postal Address
 
City
 
Country
Postal Code
 
Business Telephone
 
Business Fax
Mobile Number
Email Address
Special Dietary Requirements
Accommodation

You are responsible for your own accommodation arrangements.

Where do you plan to stay?
 
Specify
Attendance
Delegate Type
 
I will attend entire duration


I will only attend specific days - select days:  

Friday
Saturday
Sunday
Social Functions
Delegate
Accompanying
Guests
Welcoming Function
(Friday, 4 Aug)
(Free)
(x R400)  
AstraZeneca Evening Symposium
(Saturday, 5 Aug)
(Free)
(x R400)  
Payment

I am personally responsible for full payment of congress registration fees in the event that my company / organisation does not pay them.

I agree
 
Responsible for Payment
 
Method of Payment
 
Credit Card Details

Please note: Credit card details are entered at your own risk. No other parties will be held liable for any damages suffered. Thank you.

Name of Card Holder
Type of Card
Card Number
Expiry Date
(MM/YYYY)
Last 3 Digits on Reverse of Card