Garden Court Nelson Mandela Boulevard




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Garden Court Nelson Mandela Boulevard,

Kindly complete this form and return it before 16 March 2016, to: Tel.: 27 (0) 51 436 8145 Fax: 27 (086) 275 2869



E-mail: congress@internext.co.za BANKING DETAILS: Account name: Water Footprint Conference, Bank: ABSA , Account number: 405 689 3978; Branch code: 632 005, Swift code: ABSAZAJJ
Last day for Registration 16 March 2016

Surname: ________________________________________ Initials: ________________ Title: _______________________________


Name: _____________________________________________________ E-mail: _______________________________________

(The name to be printed on your name tag e.g. Mary Robberts)

Address: ___________________________________________________________________________________________________
Institution: _________________________________________________ (City/Town) _________________________________

Tel.: [w] (_______) ____________________________________ Cell number: ___________________________________________



SOCIAL FUNCTIONS

Will you attend the informal function on Monday 4 April? (included in the registration fee) Yes □ No □

Will you attend the gala dinner on Wednesday 6 April @ R350-00? Yes □ No □

Will your spouse join you for the function @ R350-00? Yes □ No □

Will you attend the Technical tour on Wednesday 6 April (included in the registration fee) Yes □ No □

ACCOMMODATION needs to be booked AND paid for by 16 March to avoid cancellation



I would like to book the following accommodation:

Garden court Nelson Mandela Hotel accommodationsingle room only @ R1 265-00 per room per night (Bed and breakfast)

Arrival date: …………………… Departure date: …………………………………. @ R1 265-00 x …. Nights R ___________


Hotel accommodationdouble (twin) room @ R1 365-00 per room per night (Bed and breakfast for 2 people sharing)

I will be sharing the room with ………………………………………………… (name of person)

Arrival date: …………………… Departure date: …………………………………. @ R1 365-00 x …. Nights R ___________

REGISTRATION FEES



Conference Registration @ R5000-00 (excluding accommodation) R ………………………
Day Registration @ R1300-00

Which day will you attend?

Monday □ , Tuesday □, Wednesday□ Thursday □



Gala dinner R350-00 x … persons R ……………………….
Accommodation R……..… x ….. nights R ……………………….

Total R ………………………..
DIETARY REQUIREMENTS

Do you have any special dietary requirements (halaal, vegetarian etc.)? ……………………………………………………………………..





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