REGISTRATION FORM (click here for a plain text version)

Structural Chemistry Indaba II

Intermolecular Interactions

3rd to 8th AUGUST 1997

NAME:
Title
Initials
Surname
STATUS:
Full Delegate Young Scientist Accompanying Person
INSTITUTE:
ADDRESS:
Postal
e-mail
Tel
Fax
DO YOU WISH TO PRESENT A PAPER?
Yes Oral Presentation
No Poster
If 'yes' please fax A4 size abstract as soon as possible so that we can complete your registration.
Abstract Title (optional):
REGISTRATION FEE:
Full Delegate @ $330 ($280 before 15th April)
Accompanying person/ young scientist @ $100
BANQUET:
Traditional dinner to be held on the evening of Tuesday 5th August 1997 @ $30
TRANSPORT FEE:
Shuttle between airport and Kruger Park @ $100 including park entrance
ACCOMMODATION DEPOSIT:
Obligatory advance payment on accommodation
Balance to be settled upon arrival
Deposit: Luxury @ $150
Deposit: Standard @ $75
Deposit: Basic @ $65
TOTAL DUE:
TOTAL SUBMITTED:
TRAVEL DETAILS:
Airline:
Flight Number:
Arrival at Johannesburg:
CANCELLATIONS:
The following penalties will apply:
Cancellation before 31 July 1997: Penalty 50%
Cancellation after 31 July 1997: No refund

If you print this form out please mail or fax it to:

s-mail: Lesley Stephenson
Structural Chemistry Indaba
CEE Conference Office
PO Box 327
Wits University
WITS 2050
South Africa
tel: +27-11-716-5091
fax: +27-11-716-7835

This site is maintained by Craig Taverner (craig@hobbes.gh.wits.ac.za)