Consortium for the Advancement of Nursing Science (Cans)

UNIVERSITY OF THE WITWATERSRAND

DEPARTMENT OF NURSING EDUCATION

CONSORTIUM FOR THE ADVANCEMENT OF NURSING SCIENCE (CANS)

BOOKING FORM – COURSES

REVERSE SIDE FOR WORKSHOPS

COURSE NAME / DATE
CAR REGISTRATION No: / VENUE

PARTICIPANT [PLEASE USE CAPITAL PRINT / TYPE]

1st NAME 2nd NAME SURNAME (as per ID) / ID / PASSPORT No: / CITIZENSHIP:
SANC NO / HPCSA NO / HIGHEST QUALIF.
CURRENT DESIGNATION / WITS STUDENT NO / IF STUDENT @ WITS
EMAIL
POSTAL ADDRESS
CELL NO / TEL NO
NEXT OF KIN / TEL NO
KINDLY ATTACH /

Copy Of Id / Passport [ ]
Copy Of SANC Receipt /HPCSA Receipt [ ]
Other (Specify) [ ]

PERSON RESPONSIBLE FOR PAYMENT [IN FULL EVEN IF DETAILS ARE THE SAME]

FULL NAME / POSITION
COMPANY / VAT NO
EMAIL [GUARANT.]
POSTAL ADDRESS
ORDER NO [IF APPL.] / TEL NO

DIETRY REQUIREMENTS

There is a cafeteria to meet a variety of dietary requirements at WITS Medical School. The cafeteria is closed on Saturdays. PS: MEALS AND REFRESHMENTS ARE AT YOUR OWN COST. (Please confirm beforehand: some special events might be inclusive of some light refreshments.)

BOOKINGS

Due to logistic processes all Bookings and Payments to be received at least two weeks before the event.
PLEASE SUBMIT THIS BOOKING FORM IMMEDIATELY. Group bookings and/or late bookings require a 50% deposit that arrives with the booking form. Please phone for special arrangements.

BANKING DETAILS [KINDLY EFT AS NO PAYMENT ACCEPTED ON THE DAY]

A COMPUTER GENERATED INVOICE/PROFORMA WITH BANKING DETAILS ON IT IS ONLY GENERATED ONCE BOOKING FORM HAS BEEN RECEIVED.

BOOKING ONLY CONFIRMED ONCE PROOF OF PAYMENT REACHES:

or (011)488-4268

NON-ARRIVALS / CANCELLATIONS: Applicants who fail to cancel in writing and/or in less than 10 days prior to scheduled dates, will be liable for 50% of current rate. Non-arrival on the day incurs full fee liability.

Acknowledge Terms & Conditions of attending above event hosted by Wits Department of Nursing Education.

APPLICANT SIGNATURE: ______DATE: ______

UNIVERSITY OF THE WITWATERSRAND

DEPARTMENT OF NURSING EDUCATION

CONSORTIUM FOR THE ADVANCEMENT OF NURSING SCIENCE (CANS)

BOOKING FORM – WORKSHOPS

REVERSE SIDE FOR COURSES

WORKSHOP / DATE

PERSON RESPONSIBLE FOR PAYMENT / GROUP PAYMENT

FULL NAME / POSITION
COMPANY / VAT NO
EMAIL [GUARANT.]
POSTAL ADDRESS
ORDER NO [IF APPL.] / TEL NO

TERMS & CONDITIONS (T’s & C’s)

DIETRY REQUIREMENTS – as per reverse side

BOOKINGS – as per reverse side

BANKING DETAILS [KINDLY EFT AS NO PAYMENT ACCEPTED ON THE DAY] – as per reverse side

BOOKING CONFIRMED – as per reverse side

NON-ARRIVALS / CANCELLATIONS – as per reverse side

CERTIFICATES – are only issued for courses and not for workshops from this institution. The Company / Client may request a copy of the attendance register for the day in order to claim skills levy rebate claim and/or for internal continued professional development record.

GROUP BOOKING (AS APPLIES TO WORKSHOPS ONLY)

Name / Surname / Email / Tel / Car Reg. No
(Parking) / Sign for Ts & Cs
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