ONLINE FORM:
Complete the form below and click to SUBMIT. You will be contacted shortly for confirmation.
Please fax your proof of payment to: 011 768 1174
DELEGATE DETAILS:
Title:
First Name:
Surname:
HPCSA Number:
Profession:
Cell No:
Tel No:
Fax No:
E-Mail:
Special Meal Requirements:
Halaal
Kosher
Vegetarian
Other - Please specify:
Registration Category:
Registration Fees:
Specialists
R 3 000.00
General Practitioners
R 2 500.00
Registrars
R 2 000.00
Nurses, Midwives & Sonographers
R 1 500.00
Trade Delegates
R 1 600.00
Day Registration:
All categories
Registrars, Midwives
& Sonographers
Friday 02 September 2011
R 1 000.00
Saturday 03 September 2011
Sunday 04 September 2011
R 1 200.00
R 500.00
Pre-Congress Workshop - 01 September 2011 (fully booked)
Ultrasonography Workshop
R 900.00
Post-congress workshop 04 September 2011 - Fetal neurosonography course
SASUOG Member
Non-Member
General Practitioner
Registrars, Nurses, Midwives & Sonographers
R1 000.00
R1 200.00
R600.00
Post-congress workshop 04 September 2011 - Pelvic floor workshop
Social Functions - Please indicate your attendance:
Cocktail Function
02 September 2011
R 000.00
(included in registration fee)
Yes, I will attend the cocktail function
No, I will not attend the cocktail function
Partners/Spouses R 150.00
Gala Dinner
03 September 2011
R 300.00
(Limited seating)
Yes, I will attend the gala dinner
No, I will not attend the gala dinner
R400.00 Partner / Spouse / Trade
For further comments or additional information :
Comments
Click here to print out the Registration Form
Please fax it to: 011 768 1174 with proof of payment.
Payment Details:
Direct deposits (credit card payment is not accepted) Name of Account: SASUOG 2011 CONGRESS Bank: STANDARD BANK Account No: 071396632 Branch code: 024909 (Mowbray Branch)
Direct deposits (credit card payment is not accepted)
Name of Account: SASUOG 2011 CONGRESS
Bank: STANDARD BANK
Account No: 071396632
Branch code: 024909 (Mowbray Branch)
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