AMESA Congress 2003
P.O. Box 632
Rondebosch
7700

e-mail: ch@inds.co.za	

Application for Financial Support
AMESA Congress 2003

I, _______________________________________ (full name and surname), would like to apply for financial support to attend AMESA Congress 2003.

Surname:	

First names	

Postal address & code	

	

Institution	

Area of expertise	

Tel:	(______) ___________________ home

	(______) ___________________ work

e-mail:										 

Please complete:

1.	I am an AMESA member YES / NO (membership number ______________)

2.	I am able to contribute R _________ of the projected R __________ costs for my attendance.

3.	I undertake to write an article/report on AMESA Congress 2003 which may be published in AMESA News.

Signature: ________________________________            Date: _______________________