Wits Sport HPC Registration Form
Friday, 22 & Saturday, 23 November or Friday, 29 & Saturday, 30 November 2019

Please E-mail your proof of payment to: nandi.buthelezi@wits.ac.za by Thursday, 21 November 2019
Title, Initials & Surname *
Company /Organisation *
Area of Interest *
Postal Address *
Telephone Number
Cellphone number
E-mail Address *
Amount Paid *
I hereby indemnify the University of the Witwatersrand against all claims for damages, injury, incapacity, death etc. that may arise from my attending the WITS SPORT HIGH PERFORMANCE COACHING PROGRAMME to be held during November 2019 at the Wits Sport Conference Centre. *
Required
Name and Surname *
Date *
MM
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DD
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YYYY
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