INTERNATIONAL LIFE SCIENCES INSTITUTE SOUTH AFRICA

Registration Form: ILSI SA Workshop

Register online at

Are South African Consumers Moving Towards Healthy Eating
07 September 2017, Marriott Crystal Towers, Cape Town
To register, kindly complete one form per delegate and email, fax or post it to Turners Conferences
Email: , Fax: 031368 6623, Tel: 031368 8000
SECTION 1 – DELEGATE INFORMATION
Last Name/Family Name / First Name (for badge) / Title: Prof/Dr/Ms/Mrs./Mr. / Nationality
Tick as required: This is my: / Private Address / Institution Address / Please fill in the relevant details below
Institution Name
Department
Institution VAT#
Contact Person’s Name
Postal Address
City / State / Post/Zip Code
Country / Phone / Mobile
Email Address (Please Print) / Fax
Special Dietary and Other Requests:
Dietary / Name / Request
Other / Name / Request
A – REGISTRATION FEES
Registration Fees – South African Rands (ZAR) Only (includes VAT)
Code (Office Use)*
Registration Category / Workshop Fee / No. of Persons / Amount
in ZAR
One Day Workshop Registration / R1710.00
Halaal Catering
Tea Break 1 / R 75.00 pp per break
Tea Break 2 / R 75.00 pp per break
Tea Break 3 / R 75.00 pp per break
(optional as workshop ends at 15:30)
Lunch / R 275.00 pp
Kosher Catering
Tea Break 1 / R125.00 pp per break
Tea Break 2 / R125.00 pp per break
Tea Break 3 / R125.00 pp per break
(optional as workshop ends at 15:30)
Lunch / R 405.00 pp
Delivery Fee / R 110.00 pp
*The hotel does not do Halaal or Kosher meals and they would need to be ordered in from a reputable supplier.
TOTAL Registration Fees / ZAR
What does the Registration Fee cover?
Participants:
Name tag, folder with abstracts, 3 three breaks, refreshments and lunch.
Cancellation Policy:
The Congress Secretariat must be notified in writing of any cancellations. All approved refunds will be issued after the workshop. An administration fee of ZAR 300.00 will be charged for all cancellations received before 31 July 2017. Please note that no refunds will be made for cancellations after 31 July 2017.
TOTAL AMOUNT PAYABLE: (Use this section to summarize your requirements and calculate the total of your payments due)
SectionsSub Totals / ZAR Amount
A Registration Fees / ZAR
TOTAL / ZAR
PAYMENT DETAILS
Please enter X in the appropriate box
Option 1
Bank Transfer / You must specify your name and the name of the conference on your bank transfer. Forward to: Turners Conferences and Conventions (Pty) Ltd.
Standard Bank
Account name: International Life Sciences Inst
Account No:421050578
Branch Code: 019205
(Please fax a copy of your transfer to Turners).
Final Date for Bank Transfers – 28 August 2017
Option 2
Credit Card / Please complete the following authorization for Congress Organizers to debit your credit card.
I, the undersigned, do hereby authorize Turners Conferences to debit my credit card for the following amounts: (if the credit card does not belong to you, please fax a copy of the front and back of the credit card to Turners)
Registration Fees TOTAL / ZAR
Credit Card Type X / Master / Visa / Diners / Amex
Credit Card Number / Expiry Date
Cardholder’s Name / 3 Digit no. on reverse side where applicable
Cardholder’s Signature / Date of Signature