Class of 2002 Reunion 16-18 November 2012

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Class of 2002

Class of 2002 Reunion 16-18 November 2012

REGISTRATION FORM

Please complete this form and return it with your payment, by 15 OCTOBER 2012.

Your details

name:

address:

Email and mobile number:

Your payment

South African Rands please. Forward a copy of your deposit slip by Fax or Email attachment to the contact below.

1. cheque (payable to “UCT”)

2. direct (EFT) deposits

Bank: Standard Bank of South Africa, Rondebosch

Account name: UCT Sundries Account

Branch Code: 02 50 09

Account Number: 07 150 3854

Type of Account:Current

Reference: 2002surname120098 eg 2002adams120098

3. internet banking Same as direct deposits

swift codeSBZAZAJJ (foreign payments)

Email notification

4. credit card

Authority for payment by CREDIT CARD to the University of Cape Town

Please debit my American Express MasterCard Visa  Other: specify

Amount:

Card number

Last three digits on back:

Expiry date:

Today’s date:

Signature (essential):

Our contact

Please complete this form and return it with your payment, by 15 OCTOBER 2012.

Post: Joan Tuff, Alumni Officer, Faculty of Health Sciences, Private Bag X3, Observatory 7935, SOUTH AFRICA.

Fax:+27 (0)86 612 6390 or +27 (0)21 447 8955 (mark for attention: Joan Tuff)

Email:

Programme

Costs

* Entry fee for own account on the day

TOTAL PACKAGEPer class member:R 795.00

+ Spouse / PartnerR 495.00= R1290.00

Name tags

Dietary preferences/allergies:

Favourite lecturers (for cocktail party) – List in order of preference:

Names of classmates who have indicated that they would like to attend thus far:

Helge Abrahamse, Eunice Adei, Gwyneth Adendorf, David Anderson, Jennie Arthur, Armid Azadeh-Ghamsari, Cora Bopape (Chinyanga), Ebrahim Dalwai, Sebastian De Haan, Sipho Dlamini, Lamiz Fayker, Robert Gill, Catherine Hanauer, Murray Heyns, Jennifer Holness, Zaid Jakoet, Nicola Kalk, Mary-Anne Kendon, Koena Kgomo, Relebohile Kose, Grant Laing, Wendy Lewis, Harsha Lochan, Sophie Mackenzie-Main, Sehlapelo Madihlaba, Tumiso Malatji, William Mapham, Kgomotso Masoga (Zukani), Portia Matjekane (Mashigo), Priscilla Mateta Silwana, Jayavani Moodley, Irene Ngobeni, Firdows Noor, Irman Parker, Jessica Paul, Alice Penn (Buchanan), Faiz Petkar, Pearl Quvane, Marcus Rademeyer, Bosele Ramantsi, Alwyn Rapatsa, Bryan Riemer, Alan Rogers, Graeme Rogers, Lynn Rosenberg, Astrid Sadler, Amaal Schroeder, Anna Sebelebele, Moahlodi Seitshiro, Moshibudi Selatole, N Setati, Joanna Skelton, Reghana Taliep, Linda Tangayi, Liesl Thomas, Kerry Timmerman, Bongumusa Tsela, Leon Varkel, Tamara Wagenheim, Thandi Wessels.