LPGSASA Cape Town Regional Workshop

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.
Workshop Fee R 0.00





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

ACCOMMODATION

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









ARRIVAL DATE
DEPARTURE DATE
Other:

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

Networking Function with snacks sponsored by LPGAS and the beverages will be a cash Bar
07 September 2010 - Networking function with snacks  Yes   No   





METHOD OF PAYMENT
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

CONFERENCE ORGANISER
 



EXCITING EVENTS, IMPORTANT DATES
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