CASA Conference 2007 Registration Form (print out and post / fax)

NAME: (include title)

____________________________________________________________________________

INSTITUTION:

____________________________________________________________________________  

ADDRESS:

____________________________________________________________________________  

____________________________________________________________________________  

E-MAIL:

____________________________________________________________________________  

ARE YOU:

Giving a paper:

 

Yes

 

No

If yes, please send abstract by 5 April 2007.

 

Please indicate your accommodation needs and the total amount you will be paying:

 

  TOTAL
Conference Fee: R800/700/400  
Foreign currency Transaction: R100 (applies to cheques only not to credit card payments)  
Conference Dinner: R200  
UCT Residence Accommodation @ R190 per night including breakfast:  
2nd   3rd   4th   5th   6th    
TOTAL AMOUNT PAYABLE:  

 

Please provide a copy of your card as proof that you are a student/pensioner.

 

Method of payment:

 

Cheque (Bank drafts are not accepted)

Made out to 'The University of Cape Town, please include reference number 420628

 

Credit Card

Please fill out credit card details form.

 

Bank Deposit/Bank Transfer

Bank Account Name: University of Cape Town

Account Number: 07-150-3854

Bank: Standard Bank

Branch Number: 025009

Branch: Rondebosch

(SWIFT CODE: SB ZA ZA JJ)

Reference Number: 420628 (this MUST be indicated in the space for ‘Reference’ under Recipient Details to ensure that the payment is made to the CASA conference account)