REGISTRATION FORM 
AMESA CONGRESS 2003

SECTION A: PERSONAL DETAILS: 

Surname:
	First name:	Title:	
Postal address:

	
		Code:	
Institution:	AMESA Membership number (if a member):
	
Telephone (home):
(      )	Telephone (work):
(      )	Fax:
(      )	
e-Mail:

SECTION B: REGISTRATION:

Please note that to qualify for early registration your form needs to be received at the Congress office by no later than 2 June 2003. For non-members, one year of AMESA membership is included in the registration fee – please complete Section F.

	Tick	Amount	
Full early registration – AMESA member @ R450			
Full normal registration – AMESA member @ R500			
Full early registration – non-AMESA member @ R535			
Full normal registration – non-AMESA member @ R585			
Day visitor (please tick appropriate days) @ R120 per day	M	T	W	T	F		
Sub-total for registration:							

SECTION C: ACCOMMODATION AND MEALS:

Please note that lunch from Monday to Thursday is included for all delegates as part of your registration fee.

	Tick	Amount	
Dinner, bed and breakfast for Sunday 29 June 2003 @ R95			
Dinner, bed and breakfast for Monday 30 June 2003 @ R95			
Dinner, bed and breakfast for Tuesday 1 July 2003 @ R95			
Dinner, bed and breakfast for Wednesday 2 July 2003 @ R95			
Dinner, bed and breakfast for Thursday 3 July 2003 @ R95			
Dinner, bed and breakfast for Friday 4 July 2003 @ R95			
Sub-total for accommodation and meals:			

Dietary requirements:
(please tick or specify)	Halaal	Kosher	Vegetarian	Other	

SECTION D: EXCURSIONS AND FUNCTIONS:

	Tick	Amount	
Bus to Waterfront for Wednesday afternoon and evening @ R10 (tickets for Robben Island, etc. can be bought at the Information table at Congress)			
Thursday night: AMESA 10 year dinner and dance @ R95			
Sub-total for excursions and functions			

SECTION E: CHILDCARE:

Childcare at R20 per child per day (includes light lunch)	M	T	W	T	F	Amount	
Sub-total for childcare							

SECTION F: AMESA MEMBERSHIP: 

Only to be completed by non-members:

Field of interest:	Primary	Secondary	Tertiary / Research	

SECTION G: SPECIAL NEEDS:

Special needs requirements (wheelchair entrance, etc.):

SECTION H: TOTAL PAYMENT:

	Amount	
Sub-total for registration (Section B)		
Sub-total for accommodation and meals (Section C)		
Sub-total for excursions and functions (Section D)		
Sub-total for childcare (Section E)		
Grand total		

PTO

SECTION I: METHOD OF PAYMENT

Please tick the appropriate box:

1.	Direct deposit to AMESA Congress 2003 (Account number 405 666 2199) at ABSA Wynberg. (A copy of the deposit slip must please accompany your registration form.)

2.	Internet transfer to AMESA Congress 2003 (Account number 405 666 2199) at ABSA Wynberg (branch code 632005). (A copy of the transaction record must please accompany your registration form.)

3.	Enclosed cheque or postal orders made out to AMESA Congress 2003.

4.	Please debit my credit card account with R . . . . . . . . .

	Type of card:	Visa	Mastercard

	Name on card:	. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

	Card number:	. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

	Expiry date:	. . . . . . . .     Signature:  . . . . . . . . . . . . . . . . . .

Please return this registration form by 2 June 2003:

by post to:		AMESA Congress 2003
P.O. Box 632
		Rondebosch
7700

or by fax to:		(021) 686 9359  
(only in the case of those paying by direct deposit, internet transfer or credit card)