Conference Registration Form

SASM 2016 Registration

CONFERENCE REGISTRATION FORM

Biennial Congress of the South African Society for MicrobiologyWebsite: http://www.dut.ac.za/sasm/

Please print and return by e-mail, regular mail or fax.

Please note that this is how you will be indicated on your badge and on the list of participants.

Indicate choices with þ.

Date: 17-20 January 2016

Place: Coastlands Hotel and Conference Centre, Umhlanga, Durban, South Africa

1. Participant information

Surname:______

Title:______£ Prof. £ Dr. £ Mr. £ Ms. £ Mrs. £ other:______

First name:______

Organisation:______

Address:______

Postal code:______City:______

Country:______

Telephone:______

Fax:______E-mail:______

Dietary Requirements:

£ Halaal £ Vegetarian £ Kosher £ Other ( ) specify

Accommodation Arrangements:

You will be required to make your own accommodation arrangements, please check our conference website for a list of recommended options.

2. Conference Fees

Conference fee includes registration, programme & abstract book, conference bag and stationery, lunches and teas and a welcoming cocktail function on 17th January 2016. Abstract books are for full delegates only.

There will be two additional social functions which you may choose to attend. Costs of these functions are for your own expense, please note that places are limited and will be allocated on a first-come basis.

PAYMENT BY: / South African Rands (ZAR):
Full Delegate (early bird) SASM members / Paid by 31 Oct. 2015 / R 3000
Full Delegate (early bird) non-members / Paid by 31 Oct. 2015 / R 3500
Full Delegate SASM members / Paid after 31 Oct. 2015 / R 3500
Full Delegate non-members / Paid after 31 Oct. 2015 / R 4000
Student (early bird)* SASM members / Paid by 31 Oct. 2015 / R 2000
Student (early bird)* non-members / Paid by 31 Oct. 2015 / R 2500
Student* SASM members / Paid after 31 Oct. 2015 / R 2500
Student* non-members / Paid after 31 Oct. 2015 / R 3000`
Plenary Lead Speaker, Welcome Cocktail & Beer Fest / R 250
Gala Dinner (Coastlands) / R 400

*If you are registering as a student, please include a copy of your valid student card!

Accompanying persons will be required to pay R1000 for the three social functions.

3. Payment

Payment information

Conference fee: (full/student) Rands ______

Accompanying person: Rands ______

Welcome Cocktail & Beer Fest Rands ______

Gala Dinner Rands ______

Total fees: Rands ______

I will pay the amount by remitting the amount to the following account:

Banking details:

Durban University of Technology

Standard Bank

Account no.: 050007068

Branch Code: 040026

Reference: SASM (Surname and Initials) or if group payment SASM (Group identifier)

Please email proof of payment to Priscilla at or fax at 0866741059