REGISTRATION FORM
=====================================================================================
         INDABA 6 - Structure and Properties  30 AUGUST - 4 SEPTEMBER 2009
=====================================================================================

 Title: _ _ _ _    Initials: _ _ _ _    First Name(s): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 Surname:  _ _ _ _ _ _ _ _ _ _ _ _ _    Name for name tag  _ _ _ _ _ _ _ _ _ _ _ _ _ 

 Department: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 Organisation: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 Postal Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 

                 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 e-mail: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 Tel: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _    Fax: _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _

 Registration:     Full _ _ _ _    Student _ _ _ _    Accompanying Person(s) _ _ _ _ 

=====================================================================================

 I will be accompanied by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 Special dietary requirements: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 Other special requirements: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 Preferred        Type A          Type B            Type C            Type D        
 accomodation:    Single _ _ _    Share +1 _ _ _    Share +2 _ _ _    Share +4 _ _ _

                  Type E Camping site:  (single) _ _ _  (sharing with 1 other) _ _ _

 I would like to share with: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

                             _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 MEALS:     Breakfasts (x 5) for _ _ _ _ people      Dinners (x 3) for _ _ _ _ people

=====================================================================================

 PRESENTATION:                Poster _ _ _ _        Oral _ _ _ _        None _ _ _ _

 Provisional Title:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

                   _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

=====================================================================================

 TRANSPORT  to Berg-en-Dal (& rtn) :  

                       From O.R.Tambo Int. Airport (Johannesburg) for _ _ _ _ people

                       From Kruger Mpumalanga Airport (Nelspruit) for _ _ _ _ people

=====================================================================================

 CANCELLATIONS: The following refunds will apply:

                           Cancellation before 30th June   |   50%
                           Cancellation after  30th June   |   No refund

=====================================================================================