CASA Conference 2005 Registration Form (print out and post / fax)
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NAME: (include title) |
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INSTITUTION: |
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ADDRESS: |
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____________________________________________________________________________ |
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E-MAIL: |
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ARE YOU: |
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Giving a paper: |
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Yes |
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No |
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If yes, please send abstract by 4 April 2005. |
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Please indicate your accommodation needs and the total amount you will be paying:
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| Conference Fee: R500/R200 | ||||||||
| Foreign currency Transaction: R100 (applies to cheques only not to credit card payments) | ||||||||
| Optional Excursion: R85 | ||||||||
| Accommodation on Campus in residence R155 per night including breakfast: | ||||||||
| 4th | 5th | 6th | 7th | |||||
| TOTAL AMOUNT PAYABLE: | ||||||||
Please provide a copy of your card as proof that you are a student/pensioner.
Method of payment:
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Cheque (Bank drafts are not accepted) |
Made out to University of KwaZulu-Natal, please include reference number R855 5205
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Credit Card |
Please fill out credit card details form.
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Bank Deposit/Bank Transfer |
Bank Account Name: University of KwaZulu-Natal
Account Number: 50871932932
Account Type: Current
Bank: First National Bank
Branch Number: 223626
Branch: Durban Corporate
Reference Number: R855-5205 (this MUST be indicated in the space for ‘Reference’ under Recipient Details to ensure that the payment is made to the CASA conference account)