|
Title
|
|
|
|
|
First Name |
Please enter the name to be printed on
your nametag. |
|
|
|
Last Name |
|
|
|
|
Position |
E.g. Researcher in Engineering, Provost, Rector, Dean, etc. |
|
|
|
Institution |
Please type in full e.g. University of Toronto, Academy of
Science for South Africa, Private, etc. |
|
|
|
Postal address |
|
|
|
|
City |
|
|
|
|
Postal/Zip code |
|
|
|
|
Country |
|
|
|
|
E-mail address |
Please use your institutional e-mail address |
|
Confirm e-mail address |
Please
repeat your institutional e-mail address |
|
|
|
|
Mobile number |
|
|
|
|
Work landline number |
|
|
|
|
Fax number |
|
|
|
|
Special needs - physical |
Please indicate any accessibility requirements. |
|
|
|
Dietary needs |
|
|
|
|
Events information |
|
|
Other than the main conference, please indicate below which
further events you will be attending. |
|
|
|
|
Workshop - 1st choice |
|
|
|
|
Worskhop - 2nd choice |
|
|
|
|
Social events |
None |
|
Welcome reception
(6 November) |
|
Gala dinner
(7 November) |
|
|
Will you require transport to and
from the gala dinner venue? |
|
|
|
|
Payment information
|
|
Please indicate how you will make your payment. Refer to the
registration page for information on processing bank deposits/wire transfers. |
|
|
|
|
Payment method |
|
Note:
If you select to pay by CREDIT CARD, only Master or Visa cards
are supported by the Stellenbosch University
online payment gateway (Safeshop). |
|
|
|
|
|
|
