19th International Symposium on Dental Hygiene

Complete the form below to register for this event.

DELEGATES DETAILS

Please complete a separate form for each delegate
Surname/Family name:
First name:
Title
Organisation:
Department/Section:
Designation:
Postal address:
Postal code:
City:
Country:
Tel No:
Cell No:
Fax No:
E-mail address:

ACCOMPANYING PERSON DETAILS
Surname/Family name:
First name:
Title
Organisation:
Postal address:
Postal code:
City:
Country:
Tel No:
Cell No:
Fax No:
E-mail address:

INVOICE DETAILS
Company Name:
Postal address:
Postal code:
City:
Country:
VAT NO:
Order No:
Purchase Order:
For attention:
Tel No:
Fax No:
E-mail address:

CONFERENCE REGISTRATION

Please note: The fees below are in ZAR (South African Rand) and must be paid in ZAR.
EARLY BIRD REGISTRATION R 2 850.00
STANDARD REGISTRATION R 3 375.00
LATE REGISTRATION R 3 900.00
PER DAY REGISTRATION R R1 425.00


NB: Early Bird fee is applicable for all registrations received before 30 APRIL 2013

ACCOMMODATION

Please reserve the following accommodation for me. Rates are per person and inclusive of breakfast.









ARRIVAL DATE
DEPARTURE DATE
Other:
Rates are subject to change, increase and availability at time of receiving your registration and are only confirmed once full payment has been received. *Hotels Terms and conditions apply*

DISABILITY ACCESS
Requirements:

SPECIAL REQUESTS
Dietary requirements:
Other:

TRANSFERS

Please reserve the following transfers:
Airport/Hotel:
Arrival date:
Arrival time:
Flight no:
Hotel or Address:
Hotel/Airport:
Departure date:
Departure time:
Flight no:
Hotel or Address:
Hotel / Conference venue:
Date:
Time:
Collection address:
Conference venue / Hotel:
Date:
Time:
Drop off address:

BANQUETING

The GALA DINNER will take place at Moyo Stellenbosch on Saturday 17 August 2013 and is not included in the registration fees.The cost is R600.00 per person.
GALA DINNER AT MOYO - R600.00   Yes   No   





METHOD OF PAYMENT

If paying by credit card a 3.5% service fee will be added. A credit card authorization form must be completed by the card holder.
By cheque:
Cheque to be made out to Confinitive PTY LTD. Please send a copy of the deposit slip.
Electronic bank transfer:
Reference No:
Date transfer sent:
Please send a copy of the EFT
Credit card:

 I have authorised you to debit my credit card with the amount indicated.
Amount: 

BANK ACCOUNT DETAILS


PLEASE FAX THROUGH PROOF OF PAYMENT WHEN PAYING BY EFT, DIRECT DEPOSIT AND INTERNATIONAL TRANSFER

Bank: Standard Bank
Account Holder:   Confinitive PTY Ltd  (T/A Embassy Conferences & Incentives)        
 
Branch: Cape Town
Branch Code: 051-001 
Account Number: 070-013-861
 
Account Name: Confinitive (PTY) LTD
Account Type: current Account
Swift  Code: SBZAZAJJ  
 

CONFERENCE ORGANISER

EMBASSY CONFERENCES & INCENTIVES
(Formerly Confinitive PTY LTD)
 
ADDRESS: P.O BOX 84 Cape Town 8000 South Africa

CONTACT: Annie Lin or Karen van Der Bergh

TELEPHONE: +27 (0) 21 424 6644
FAX: +27 (0) 21 422 4320
E-MAIL ADDRESS:  annie@singergroup.co.za or karen@singergroup.co.za

WEBSITE:  www.embassyconferences.co.za

 
 



EXCITING EVENTS, IMPORTANT DATES
&
MUCH MORE
 
A PROUD MEMBER OF THE SINGER GROUP