Planning, Monitoring, Evaluation and Learning for Development Projects

Planning, Monitoring, Evaluation and Learning for Development Projects

Planning, Monitoring, Evaluation and Learning for Development Projects

5 – 9 March 2018, Cape Town, South Africa

REGISTRATION FORM

Please complete this form and send back to Southern Hemisphere on fax number: +27 (0)21424 7965 or email: due on 20 February 2018

SECTION A: LEARNER INFORMATION
TITLE:(Ms/Mrs/Ms/Dr…)
FIRST NAME/S: / Indicate as it should be noted on the course certificate
SURNAME: / Indicate as it should be noted on the course certificate
DATE OF BIRTH: / Y / Y / Y / Y / M / M / D / D
IDENTITY / PASSPORT NUMBER:
CITIZEN RESIDENT STATUS: (Please tick) / South African / Other (pls specify) / Dual
NATIONALITY:
HOME LANGUAGE:
GENDER: (Please tick) / Female / Male
SOCIO-ECONOMIC STATUS: (Please tick appropriate box) / Employed / self-employed / Unemployed
Company name:
Company VAT number:
Payer Address (including country):
TELEPHONE: / CELL:
EMAIL: / FAX NO:
EQUITY: (Please tick) / Black / Coloured / White / Indian-Asian

PROVINCE: (Please indicate by placing a tick next to the appropriate box)

Western Cape / Free State / North West
Eastern Cape / KwaZulu Natal / Northern Province
Northern Cape / Gauteng / Mpumalanga

DISABILITY STATUS: (Please indicate by placing a tick next to the appropriate box)

Sight (even with glasses) / Physical (move / stand) / Emotional (behavioural / psych) / Multiple / Disabled (but unspecified)
Intellectual (learn, etc) / Hearing (even with hearing aid) / Communication (talk / listen) / None

PLEASE INDICATE HOW YOU HEARD ABOUT THE TRAINING WORKSHOP:

Email / Newsletter / Internet / Word of mouth
Any previous training with Southern Hemisphere? / Y/N? / If yes, please state which?
SECTION B: REGISTRATION DETAILS
WORKSHOP FEES:R11,842.11 (excl VAT) or R13,500 (incl VAT) per delegate
EARLY BIRD FEES: 10% discount if payment is received by 1 February 2018
Note:10% discount per delegate if organisation sends 3 or more delegates

TERMS AND CONDITIONS:

  1. WORKSHOP FEES are inclusive of refreshments, luncheons, programme materials and certificate.
  2. Payment Terms: No registration can be confirmed until Southern Hemisphere receives a faxed/emailed copy of the proof of deposit and a signed registration form by20 February 2018.
  3. We reserve the right to refuse admission if payment is not received on time. Unless otherwise stated, payment must be made in SA Rand.
  4. Cancellation / Substitution: provided the total fee has been paid, substitutions, at no extra charge, up to 14 days before the event are allowed. Otherwise all bookings carry a 50% cancellation liability immediately after this signed sales contract has been received by Southern Hemisphere. Cancellations must be received in writing, by email or fax, one (1) week after registering for the event, in order to obtain a full credit for any future similar event. Thereafter, the full event fee is payable and is non- refundable.
  5. Non-payment or non-attendance does not constitute cancellation. By signing this contract, the client agrees that in case of dispute or cancellation of this contract that Southern Hemisphere will not be able to mitigate its losses for any less than 50% of the total contract value.
  6. If, for any reason, Southern Hemisphere decides to cancel or postpone this event, is not responsible for covering airfare, hotel, or other travel costs incurred by clients. The event fee will not be refunded, but can be credited to a future event. In the event that Southern Hemisphere permanently cancels the event for any reason whatsoever, (including, but not limited to any force majeure occurrence) and provided that the event is not postponed to a later date, the Client shall receive a credit note for the amount that the Client has paid to such permanently cancelled event, valid for up to one year to be used at another event. No refunds, part refunds or alternative offers shall be made.
  7. Important note: While every reasonable effort will be made to adhere to the advertised package, Southern Hemisphere reserves the right to change event dates, sites or location or omit event features, as it deems necessary without penalty and in such situations no refunds, part refunds or alternative offers shall be made.
  8. Event programme content is subject to change without notice.
  9. Copyright, etc: All intellectual property rights in all materials produced or distributed in connection with this event is expressly reserved and any unauthorized duplication, publication or distribution is prohibited.

FOOD PREFERENCES (Please indicate by placing a tick in the appropriate box):

Halaal * / Kosher * / Vegetarian / Other: please specify: / None

*please note that there may be an extra charge for Halaal or Kosher meals ordered

SOCIAL MEDIA:

Twitter handle / Facebook page

METHOD OF PAYMENT (Please indicate your payment method):

Bank transfer / Open Space Consultants cc T/A Southern Hemisphere, The Standard Bank of South Africa, Branch Code: 020009, Cheque Account No: 070498288, Swift code: SBZAZAJJ
Cheque / Made payable to Southern Hemisphere cc

AUTHORISATION: (Signatory must be authorised to sign on behalf of the contracting organisation. This booking is invalid without a signature.)

By signing, I fully understand and agree with the terms and conditions as set out above. I realise that this document constitutes a legal binding sales contract.

Signed at ………………………………………….. on the ………………………… day of …………………………….. 201………… .

For delegate:…………………………………………………For Southern Hemisphere: ………………………………………………