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E-REGISTRATION FORM

AMESA CONGRESS 2013

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CONTACT DETAILS

Title: / First name: / Surname:
Postal address:
Postal code:
Name of school or institution:
Your e-mail address:
Home tel: / Work tel: / Fax: / Cell:

AMESA MEMBERSHIP

It is AMESA policy that all participants must be paid-up AMESA members.

Are you a current paid-up AMESA member? Please tick/click: / Yes / No
If yes, please type your AMESA membership number:
If no, complete the AMESA membershipapplicationform and enter the appropriate membership fee here: / Amount (R)

REGISTRATION FEE

Please type the appropriate fee. The date-policy will be strictly enforced. / Amount (R)
Early registration:R850(by 30 April)
Normal registration:R900 (1 Mayto 31May)
Late registration:R1300 (1 June to 18 June)
OR / Mon / Tue / Wed / Thu / Fri / Amount (R)
Day visitors: Please tickthe appropriate days@ R300/person/day
Congress materials will be available for day visitors at an additional cost of R350, provided your registration is received by 10 June

UWC HOSTEL ACCOMMODATION(including breakfast)

Tickthe nightsand enter the amounts / Sun / Mon / Tue / Wed / Thu / Amount (R)
Single occupation @ R225/person/night
Double occupations@ R200/person/night
Write here the name of your roommate:
Tick the days for dinner @ R55/person/meal

EVENING FUNCTIONS

Type the amounts for your choices: / Amount (R)
Tuesday 25 June: Cultural evening@ R120
Thursday27 June: Gala dinner@ R350

EXCURSIONS

Type the amount for JUST ONE choice (see Announcement for details): / Amount (R)
Cape Peninsula @R225
Cape CBD & Waterfront@R180
Table Mountain & Waterfront @R300
Robben Island & Waterfront @R300
Township tour@R200
Wine tour @R275

MEMORABILIA

Tick the sizeand enter the amounts: / S / M / L / XL / 2 XL / 3 XL / 4 XL / Amount (R)
Hooded rain jacket @R300
Golf shirt (long sleeve) @R180
Scarf (one size) @ R40
Beanie (one size) @ R40

TRANSPORT

I would like to book transport to/from ...
Tick: / Cape Townairport
(R75 one way) / Parc Du Cap (Bellville)
bus terminus
(R50 one way) / Mabel street (Oakdale, Bellville) bus terminus
(R50 one way) / Bellville train station
(R50 one way)

Arrival preferred transport time (tick):

Sunday 23 June / Monday 24 June / Amount (R)
10:00 / 14:00 / 18:00 / 20:00 / 08:00 / 10:00 / 14:00

Departurepreferred transport time (tick):

Friday 28 June: / 10:00 / 13:30 / 15:30
Amount (R)
TOTAL AMOUNT PAID:

Go to next page for more information

DIETARY REQUIREMENTS

Dietary requirements:
(tick, if any) / Vegetarian / Halaal / Kosher / Diabetic

PRE-CONGRESS WORKSHOP (Sunday 23 June, 14:00-17:00)

Only if you plan to attend one of these workshops, tickyour choice:

Patterns, algebra and functions for Foundation Phase
Playing with geometry in the Senior Phase
Patterns all around us for Intermediate Phase
Geogebra for teaching and learning high school mathematics

ANYTHING ELSE?

Type here anything else you want to bring to the attention of the organisers:

Note: Your registration is not complete until we receive your full payment.

Go to payment details

PAYMENTFORM

Please tickyour method of payment and complete:

Internet Payment or Bank Transferto:
Account Name:AMESA Congress
Name of Bank:ABSA
Account Number: 9271293382
Type of Account: Cheque Account
Branch Name: Wynberg
Branch Code: 632005
Clearly enter your nameand/or membership numberin the reference section.
Proof of payment must accompany this registration form
The onus is on you to ensure that we receive the relevant information
Cheque or postal ordermade out to AMESACongress for / R
Debit my credit card account (Visa and Mastercard only) with / R
Card number: / 3 digits on back:
Tick your method of payment: / Straight / Budget: 6 months / Budget: 12 months
Name on card: / Expiry date:

Please return thiscompletedRegistration Form and Payment Form and,where necessary, your Membership Formoverleaf and send with (proof of) payment:

By fax to:021-9591508 or 021-9591524 (only if you are not paying by cheque)

By e-mail to: (only if you can attach the necessary forms)

By post to:The Congress Secretary

Kim Styer

Room 61 (A-Block)

Faculty of Education

University of the Western Cape (UWC)

Private Bag X17

Bellville

7535

Note: Your registration is not complete until we receive your full payment

AMESA MEMBERSHIP APPLICATION/RENEWAL FORM

If you are NOT a current paid-up AMESA member, you need to complete this section.

Please complete in full and in capital letters
  1. Membership no.(if renewal):

  1. Province:
/ Branch (if known):
  1. Membership type (tick):
/ Individual / Institutional / Associate (student)
  1. Field of interest(tick):
/ Primary / Secondary / Tertiary
  1. For Individual and Associate members only:

Surname: / First name: / Title:
Postal address:
Postal code:
Telephone (home): / Telephone (work): / Fax: / Cell:
E-mail:
  1. For Institutional members only:

Designation of person to whom correspondence should be addressed (e.g. HOD Mathematics/Librarian):
Name of Institution:
Postal address:
Postal code:
Telephone: / Fax: / Cell: / E-mail:
  1. For student (associate) members only:
    I hereby declare that I am a full-time, pre-service student at the following institution:

To qualify as a student member, you must include proof of registration at the tertiary institution.

  1. Membership subscription fee:

Tickone, and then include the amount in the membership sectionon the first page
South Africa, Individual: R120
South Africa, Institutional: R340
South Africa, Associate (Full Time Student at a Tertiary Institution): R30
South Africa, Life Membership: R3000
Other African countries, individual: R150
Non-African countries, individual: USD65