Delegate Registration form
Payment Procedure

Please Note:

Payment must be made within 14 days of receipt of invoice thereafter you seat will be reallocated as seat are limited - full payment on receipt of invoice will secure your seat!

Delegate Personal Details
Surname *
Your answer
First name *
Your answer
Title
Name on Delegate Badge
Your answer
IWMSA Membership Number
Your answer
Organisation / Company Name
Your answer
Person Responsible for Payment
Surname *
Your answer
Name *
Your answer
Telephone Number *
Your answer
E-mail *
Your answer
Registration information
All prices are inclusive of VAT and payable in Rands

*GROUP DISCOUNT (only applicable to IWMSA Member and NON Member):
- 2 - 5   Delegates 5% discount
- 5 - 10 Delegates 10% discount

Registration *
Evening Functions *
Please indicate if you will be attending
Required
Untitled title
Dietary Requirements - select one only
Please note that all Kosher and Halaal - Strict meals will be invoiced for at an additional cost.
Technical Tours
Technical Tour, Early Bird @ R600.00, Normal Price R650
Contact Information
E-mail
Your answer
Mobile
Your answer
Telephone *
Your answer
Invoice / Postal Address
Your answer
South Africans, please indicate which province you are from
Region *
Country *
Your answer
V.A.T Registration Number
Your answer
Please indicate if we are able to share your contact details with interested parties *
Please indicate where you heard about the conference *
Credit Card Payment Facility available
If you would like to pay via Credit Card please mark below:
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