PERSONAL DETAILS (Please Print Clearly)

Please complete the Registration Form and e-mail, post or fax it to InterAction Conferencing, University of KWAZULU-Natal, Graduate School of Business Building, Francois Road, Durban, 4041.Telephone (031) 260-1607/1182 Fax (031) 260-1606 E-Mail : Website : http://www.ukzn.ac.za/aam2004

PERSONAL DETAILS (Please print clearly)

TITLE : ______SURNAME : ______FIRST NAME : ______

POSTAL ADDRESS :______

______CODE : ______

INSTITUTION/ORGANISATION : ______

TELEPHONE ( ) ______(W) ( ) ______(H)

______(CELL) FAX : ( ) ______

E-MAIL : ______SPECIAL DIETRY REQUIREMENTS : ______

REGISTRATION FEES - (Special Concessions will be considered)

The following costs will be covered by your conference registration fees :

·  Tea/Coffee Breaks during conference on all days

·  Lunch during conference on all days

·  Opening Banquet

·  Premiers Reception

·  Cocktail Evening

·  Conference Bag & Materials

·  Conference Proceedings

REGISTRAITON FEES
(Please tick appropriate box)
Before 9 October 2004 / On-Site
Full Delegate / R 500.00 / R 600.00
Student / R 150.00 / R 250.00
Day Delegate(Maximum of 1 Day Only) / R 150.00 / R 200.00
SUB TOTAL A / R
SOCIAL EVENTS(Please confirm your attendance by ticking the appropriate box)
FUNCTION / YES, I will be attending / NO, I will not be attending / Day Delegate / Cost for Accompanying Person
Opening Banquet : Sunday, 10 October 2004 / R 200.00 / R 200.00
Premier’s Reception : Monday, 11 October 2004 / R 150.00 / R 150.00
Cocktail Evening : Tuesday, 12 October 2004 / R 80.00 / R 80.00
SUB TOTAL B / R

TOTAL DUE = R ______

Please be advised that payment details must be submitted together with your registration forms. Payment can be made in the following ways : (Please tick applicable box)

1CHEQUE 1DIRECT DEPOSIT 1BANK TRANSFER 1CREDIT CARD

A copy of all direct deposits and bank transfers must be attached to your registration form.

CREDIT CARD PAYMENTS

ONLY VISA AND MASTERCARDS ACCEPTED

Credit Card Number Card Type : 1 Visa 1Mastercard

Expiry Date ______/ ______Last 3 digits on back of card : ______Amount to be debited ______

Cardholders Name ______Signature of Cardholder ______

(A photocopy of both the front and back of the credit card to be provided with your registration form)

BANKING DETAILS

ACCOUNT NAME : AAM 2004

BANK : Standard Bank

BRANCH : Gale Place

ACCOUNT NUMBER : 051 835 983

TYPE OF ACCOUNT : Current Account

BRANCH CODE : 042526

SWIFT ADDDRESS : SBZAZAJJ

(International transfers)

Alternatively, please make a cheque payable to The University of KwaZulu- Natal and post it together with you registration forms to:

INTERACTION CONFERENCING

UNIVERSITY OF KWAZULU-NATAL

OFFICE NO 329

GRADUATE SCHOOL OF BUSINESS BUILDING

FRANCOIS ROAD

DURBAN

4041

SOUTH AFRICA