OSSA 2018 Ophthalmic Personnel Payment Registration Form Page 2

OSSA 2018 Ophthalmic Personnel – Payment Registration Form Page 2

Invoicing / Payment / Company / Practice Details
Company Name
VAT No
Tel (w)
Fax (w)
Address line 1
Address line 2
City
Postal code
Country (if not SA)
Contact Person
E-mail
Total Amount Payable (ZAR)
How many registrations are included in this payment?
10% Group Registration discount will apply when registering 6 or more personnel from the same practice / clinic
Group Registration: List the Attendees included in this payment
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Pay by EFT or bank draft Bank: STANDARD BANK Branch Code: 012345 Swift Code: SBZAZAJJ (IBAN: N/a)

Account No: 012150053 Name: OSSA Congress Reference: OSSA 2018 - Attendee name