MAXILLO- FACIAL & ORAL SURGEONS ANNUAL CONGRESS 2014
Friday 17thOctober – Sunday 19thOctober 2014
Southern Sun Elangeni and Maharani - Durban

REGISTRATION FORM

Prof/Dr/Mr/Mrs/Ms ... First Name:...... Surname:......
Address: ......
Postal code: ...... HPCSA No/Nr (if applicable):......
Tel: ...... Fax: ......
Mobile: ...... E-Mail: ......
ACCOMPANYING PERSON
Prof/Dr/Mr/Mrs/Ms ……….. First Name: ………………………………………………Surname: …………………………………………………………
REGISTRATION FEES / Before 30 August 2014 / After 30 August 2014 / Onsite / Please select
SASMFOS Members / R3 600 / R4 600 / R 5 600
SASMFOS Member Daily / R1 450 / R 1 850 / R 2250
IAOMS Members / R4200 / R5100 / R 6200
IAOMS Member Daily / R1700 / R 2100 / R 2500
Non-members / R4 600 / R5 600 / R 6 600
Non-members Daily / R1 800 / R 2200 / R 2 600
SASMFOS Registrar member* / R2000 / R3 500 / R 4 500
Registrars Daily* / R 850 / R 1 400 / R 1 800
*Letter from Head of Dept or proof of registration required

ACCOMPANYING PERSON FEE:
R200/day (please tick) Friday Saturday Sunday (no charge)
For Friday: R200 fee includes daily teas and lunch, access to exhibition and cocktail evening, but excludes access to the scientific sessions*.
For Saturday: R200 fee includes daily teas, lunch and access to exhibition, but excludes access to the scientific sessions* and Gala dinner (R150 extra).
For Sunday: No cost. Will have access to daily teas and exhibition, but excludes access to the scientific sessions*.
(*for queries or exceptions, please contact Dr Boyes-Varley via e-mail.)
For all registrants: If attending on a daily basis please state day/s:
Friday Saturday Sunday
Full conference fee includes teas, lunches, registration material, access to scientific sessions, exhibition and welcome reception but excludes Conference Gala dinner.
Daily conference fee includes tea/lunch, registration material, access to scientific sessions and exhibition for one. All fees include VAT.
SOCIAL PROGRAMME
Please circle below
1. Golf
Thursday 16thOctober 2014 Yes / No...... Number
Handicap …………………
2. Cocktail Evening with the Traders
Friday 17thOctober 2014 Yes / No...... Number
Venue: Southern Sun Elangeni and Maharani
3. Conference Dinner
Saturday 18thOctober 2014
R 150 per person Yes / NoNumber ......
Venue: Southern Sun Elangeni and Maharani
DIETARY REQUIREMENTS None
Accompanying person None
requirements /
Vegetarian
/
Strictly Halaal
/ Strictly Kosher
Vegetarian
/
Strictly Halaal
/ Strictly Kosher
PAYMENT INFORMATION
PLEASE COMPLETE / Registration fees
Accompanying person fee
Social Programme fees
TOTAL
PAYMENT INFORMATION
  1. Bank deposits: Please see banking details below and fax the deposit slip to
  2. Internet transfers: Please fax proof of payment to 0866895054 or
  3. Cheques: Please see account name and address below. No foreign cheques.
  4. Postal orders and travellers cheques will NOT be accepted.
  5. The completed registration form together with the relevant payment must be received no later than 30 August 2014, in order to benefit from the reduced early registration fee.
  6. Please ensure that the name of the Delegate is stated on the bank transfer.
  7. Bank charges are the responsibility of the delegate and should be paid at source in addition to the registration fees.
  8. Registration will only be valid upon receipt of the full payment by the registration department according to the deadline indicated. Your registration is not guaranteed without payment.
  9. Outstanding payments will be collected on-site and charged the on-site rate. A copy of the bank transfer (or other proof of payment) will be required in the event that registration fees were not credited to the meeting account on time.

Banking Details: EFT DEPOSITS ONLY
Name of Account: The Sasmfos
Bank: Investec Bank
Branch Name: 100 Grayston Drive
Branch Code: 580105 [add “00” for transfer from Standard Bank]
Account Number: 50002178913
For queries please contact the Treasurer: Dr. Rinus Beukes on 021 – 852 0545
CANCELLATIONS
Cancellations should be e-mailed to Vivesh Rughubar. Before 20 August 15% cancellation fee applies. Thereafter 100% cancellation fee applies.
PLEASE RETURN THIS FORM AND PROOF OF PAYMENT TO:
Vivesh Rughubar, PO Box 561733, Chatsworth Durban, South Africa
Tel: 0825754051 / Fax: 0866895054 / Email: