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SGI Western Cape 2017 – Regional Course Registrations
Welcome to the online application for our wonderful regional course from Friday 10 November 15h00 to Sunday 12 November 2017 at Manyano Centre in Paarl (40 mins from Cape Town). Please fill in all the questions that are relevant to you.

The total course fee will be R700 (EXCLUDING BEDDING & TRANSPORT)

This form should be completed by Sunday 1 October 2017 (Kosen-Rufu Gongyo).

To complete your registration, you must submit a non-refundable deposit of R300 by 20 August 2017 (Gosho Study). The total course fee will be R700. Alternatively full payment must be made by 1 October 2017.

Bank Deposits and Internet Transfers must be made to:
Name of Account: SGI South Africa
Name of Bank: ABSA
Branch Number: 632005 (Melville Branch)
Account Number: 4070127561
Type of Account: Current A/C
IMPORTANT: Your payment reference is RC Initial&Surname (EG: RC J Blog)

Please email proof of payment to SGI.CPT.REG@gmail.com. All queries regarding the course should go to this email address.

-Transport is not included in the course fee, please indicate if you require transport in the form below.

-Bedding is available at the venue for R80.00 per member. Please indicate below if you want bedding.

-Out of Town Members, please note:
You are responsible for your own accommodation on the days before and after the course if you are arriving early or departing late.

KEY CONTACTS

ACTION CHIEF: Hermann Mayouma (hermann_loya@yahoo.fr) 0783125514
REGISTRATION: Anita George (Anita.George@yahoo.com) 0845485589
FINANCE & PAYMENTS: Robert Mulligan (SGI.CPT.REG@gmail.com) 0824665113

Email address *
Name *
Your answer
Surname *
Your answer
Address *
Your answer
Home Telephone Number
Your answer
Work Telephone Number
Your answer
Mobile Number *
Your answer
Group Name *
Your answer
Group Leaders Name *
Your answer
District Leaders Name
Your answer
Division *
Required
Are you an out of town member? *
If from out of town which city are you from?
Your answer
Do you have any Allergies? *
Your answer
Do you have any Medical Conditions we should know about?
Your answer
Doctors Name and Telephone Number? *
Your answer
Medical Aid Name and Number
Your answer
Emergency Contact Name *
Your answer
Emergency contact relationship *
Required
Emergency Contact Name and City? *
Your answer
Dietary Requirements? *
Any Special Request?
Your answer
Do you require bedding? (R80 pay on arrival) *
Do you snore? *
Are you a light sleeper? *
Do you require transport to and from the venue? *
Are you willing to offer someone a lift from Cape Town? *
A copy of your responses will be emailed to the address you provided.
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