Registration

Title:

Surname:

First Name(s):

Affiliation:

Address:

Telephone Number:

E-mail Address:

Presentation Title:

Presentation Abstract:

Any special dietary requirements?

Are you interested in participating in the Wednesday, 1 February excursion? NB: the excursion is not included in the (free) registration.

    Yes    No    Maybe

Dates of arrival and departure (possibly tentative), and, if possible, a mobile telephone number
Do you require any assistance booking accommodations? If no, skip the next two input boxes.

    Yes    No

Please specify the number of persons that require accommodation and/or any other relevant information, e.g. single, sharing, wheelchair access, etc.
Please specify the dates for which you require accommodation to be booked; e.g. IN 6 November OUT 12 November for arrival on the afternoon of 6 November and departure on the morning of 12 November.

We have access to very limited funds set aside for supporting travel and local costs. If you require assistance in order to attend, please specify the minimum amount necessary and indicate, e.g., whether the funds would go towards airfare, accommodation, etc.
Are you a South African student applying for financial assistance?

    Yes    No