REGISTRATION FORM

⁠Wolfson Lecture Theatre, UCT Faculty of Health Sciences, Anzio Road, Observatory

Cape Town, South Africa

Contact Details

Primary Address

REGISTRATIONS (Early registration closes on 30 June 2019)

AMOUNT
ZAR 2,200.00
TOTAL
AMOUNT
ZAR 2,500.00
TOTAL
AMOUNT
ZAR 2,800.00
TOTAL
AMOUNT
ZAR 3,300.00
TOTAL

Social Functions

Gala Dinner

AMOUNT
ZAR 450.00
TOTAL
AMOUNT
ZAR 450.00
TOTAL

Accessibility

Dietary Requirements

Summary

Payment

Payment Information:

Bank Account Details

 

Cancellations should be made in writing e-mailed to Janet Sirmongpong at the address below.

A 15% cancellation fee applies before 15th July 2019 – thereafter a 100% cancellation fee will apply.

Bank

Standard Bank

Branch

Mowbray

Branch Code

024909

Account Holder

Conference Management 02

Account Number

071-278-850

Swift Code

SBZAZAJJ

*Please note that we do not accept foreign cheques

*Proof of payment should be sent to janet.sirmongpong@uct.ac.za

*Please note that all bank charges are for your OWN account

Thank You


Thank you for registering for the 2nd All Africa Clinical Trial Summit.

You will receive a confirmation letter and invoice for your registration via email soon.

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