REGISTRATION FORM
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                 INDABA IV - PATTERNS IN NATURE  17-22 AUGUST 2003
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 Title: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _      Initials: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 Surname:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 Institute:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

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

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

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

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

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

 Preferred accomodation:        Single _ _ _      Share +1 _ _ _      Share +2 _ _ _

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

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

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

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

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 REGISTRATION FEE:         Enclosed _ _ _ _             Direct Bank Transfer _ _ _ _

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 Total Submitted:                                           |   
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 TRAVEL DETAILS: (complete only if bus transport is required)

 Airport:            Johannesburg _ _ _ _ _ _ _      Kruger Mpumalanga _ _ _ _ _ _ _

 Airline: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _      Flight No:_ _ _ _ _ _ _ _ _ _ _

 Arrival time & date:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 Bus from Skukuza to:   Durban _ _ _   Johannesburg _ _ _    Kruger Mpumalanga _ _ _

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 CANCELLATIONS: The following refunds will apply:

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

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