REGISTRATION
8 - 10 OCTOBER 2024 | UNIVERSITY OF THE WESTERN CAPE

Delegate personal details

Title (Mr, Mrs, Dr, etc) *

First name *

Surname *

Preferred first name for name badge *

Preferred full name for your certificate *

Institution *

Designation/Profession *

Country *

Telephone number *

Mobile number

E-mail address *

Dietary requirements *

Food allergies

Please select the appropriate registration option *

I am registering as a Speaker

I am registering as a Delegate / Attendee

I am registering as a Presenter

Registration fees

For more information on registration fees please click here. Registration fees are in South African Rand (R).

Select registration: *

Early Bird registration - R 4,950.00 (valid until 16 August)

Standard registration - R 5,300.00 (valid until 1 September)

Late registration - R 5,500.00 (closes 1 October)

Registration cost

Events

Will you attend the Welcome Cocktail Function on 8 October 2024?
The cost is included in the registration fee. *

Yes

Will you attend the Gala Dinner on 9 October 2024?
The cost is included in the registration fee. *

Yes

Travel arrangements

Flights can be booked through XL Millennium Travel and this will be quoted and invoiced through to you separately.

Would you like XL Millennium Travel to assist you with travel arrangements? *

Yes

Departure city

Preferred airport of departure

Date of departure

Preferred time of departure

Date of return

Preferred time of return

Airline loyalty card membership number

Seating preference

Please upload a copy of your ID document *

Cost summary

Additional costs for this registration

Additional costs details

VAT included in this registration

Costs for this registration

Please select a payment option for your registration *

Bank Transfer / EFT

Credit Card

Transaction Levy

TOTAL COST

All prices are in South African Rands.

Billing information

Company/institution to be billed *

Billing contact person *

Billing person contact number *

Billing contact person email address *

Billing address *

If you require your organisation's VAT number on your invoice, please supply that VAT number:

Payment information

Once you have submitted your registration form, you will receive an invoice, with payment details. Your registration cannot be confirmed until full payment has been received.

Additional information

Emergency contact person name and telephone number *

Is there any additional information that you would like to provide?

POPIA DISCLAIMER

In accordance with the Protection of Personal Information Act, all personal information provided will solely be used for the purpose of this event.

Click here to view the XL Millennium policy.

I have noted the POPIA Disclaimer *

Abstract speaker

Delegate type

CC/POP/PO Received

Date

Amount

Paid to date

Outstanding balance

Payment Details

Hidden Notes

Cancellation

* = Input is required

REGISTRATION 8 - 10 OCTOBER 2024 | UNIVERSITY OF THE WESTERN CAPE