Foundation for Sport, Development and Peace
foundation for Sport, Development and Peace
Registration Form
INTERNATIONAL CAPE TOWN SPORT AND PEACE CONFERENCE AND EXPO
The Power of A Dream
The Foundation in partnership with DCAS, Nedbank/Old Mutual and the City of Cape Town and their partners are happy to invite you to the above Conference.
14-16 September, 2016
Nedbank Building, Waterfront
Cape Town, South Africa
Please read through the information below and then return this form to the Foundation for Sport, Development and Peace via e-mail
For successful registration to the conference this form has to be completed and returned by:
Registration: 15 August 2016: R 300 (includes conference reception)
Late Registration:5 September 2016R 450 (includes conference reception)
The Foundation has 10 subsidizedentries available (attendance free) and applicants should send a written motivation for one of these positions by 31 July 2016
☐I hereby confirm my participation in one of the accredited training course on 14+15 September (please complete separate Registration form for Training).
☐I hereby confirm my participation in the EXPO with a stand on 15 September
☐I hereby confirm my attendance of the Conference Dinner 15 September
☐I hereby confirm my participation in the Conference on 16 September and my choice of the specific Commission I will be attending will be (please tick one of the 4 Commissions below).
Commission 1 / Universal and Olympic Value Education for Youth and Leadership(Room 1)Chairs: Dr.Marion Keim and Mr. Bennett Bailey (DCAS)
Commission 2 / Health and Wellness (Room 2)
Chairs: Prof. Tim Noakes and Grassroots Soccer
Commission 3 / Community Safety, Sport and Peace in the City(Room 3)
Chairs: Prof.Christo de Coning and SnSup.WendyDreyden
Commission 4 / Community Development and Partnerships (Room 4)
Chairs: MsNarimanLaattoe and City of Cape Town
* Mandatory fields
1. Personal Contact Details*Last name:
* First name:
Middle initial:
Date of Birth:
*Nationality(ies):
*ID or Passport number:
*Gender: ☐female ☐male
*Organization:
*Current position:
*Address:
*City: / State:
*Postal Code: / *Country:
*E-mail: / Website:
*Phone: / Mobile phone:
Fax: / Skype-ID:
2. Information About Your Involvement in Sport, development and Peace
*Areas of expertise / research interests
*Professional Experience in the Area of SDP through sport -
YearPositionOrganization/InstitutionCountry
3. Information About Your Organization/Institution
*What are the main objectives of your organization/institution?
*What are the main Target Groups of your organization/institution?
.
*How is sport used to reach the objectives mentioned above within your organization/institution?
The Expoon 15 September2016will enable you to present your work during the Conference. If you have posters, photo material, special objects or stories illustrating your work, please mention these below to help us prepare these sessions prior to the Conference.
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4. Special Requirements
Please let us know if you have any special requirements regarding e.g. disabilities, language or dietary requirements:
banking details
Foundation for Sport, Development and Peace NPC
Bank: ABSA
Bank Code: 632005
Acc.No: 408 485 1625
Swift Code: ABSA ZA JJ
completed registration forms and proof of payment should be sent to the organisationcommittee
Email:
Phone:Marion 082202 3454, Nariman 083566 2981 or Heidi 083261 9108
If you cannot attend the Conference but would like to suggest someone else from your organization to participate in this event, please pass this information on to interested colleagues.
If you have any questions or remarks regarding your registration to the Conference, please contact us on:
or callMarion on 082202 3454, Christo on 0824637866, Narimanon 083 566 2981 or international call: +2782 202 3454 .
We are looking forward to seeing you in Cape Town 14-16 September !!!
Foundation for sport, development and Peace
Marion Keim LeesChairperson and Conference Convener
Christo de ConingDirector
Heidi RaymerDirector Cooperate Affairs
Nariman Laattoe Expo Coordinator
Warren Lucas Youth Coordinator
other board members
Dr Anver Desai
Mr. Jan Koster
Ms Ntombise Mene
Dr. Chimwemwe A.P.S. Msukwa
Ms Thandeka Tutu-Gxashe
Foundation for Sport, Development and Peace
The Foundation is a non-profit, non-governmental organization engaged in sport, development and peace and promoting the Olympic values of friendship, fair play, respect, excellence and balance of body, spirit, will and mind for social change and the development of a better society.
is: