Registration and General Information
REGISTRATION CATEGORY:
     
Title -----
First Name ----- *
Surname ----- *
Gender -----
Male

Female
Organisation / Company ----- *
Mailing Address: ----- *
  -----
  -----
City: ----- *
State / Province: ----- *
Tel ----- *
Fax ----- *
Mobile ----- *
Email ----- *
HPCSA / MP Number ----- SA Delegates only
Dietary Requirements
  Vegetarian -----
  Halaal -----
  Kosher -----
  None -----
  Other -----
     
DELEGATE REGISTRATION INFORMATION    
  Registration Fee    
FULL CONGRESS          
ISAM Member R 4 000    
ISAM Affiliated Society Member R 4 500    
Non ISAM Member R 4 500    
S.A Residents & Mental Health Workers R 2 500    
Sunday Monday Tuesday Wednesday Thursday
DAY REGISTRATIONS: R 1 000 R 1 000 R 1 000 R 1 000 R 1 000
         
Workshop        
Pre-conference workshop R 600    
         
Social Functions Indicate your attendance:  
Gala Dinner R 300
Partner / Spouse Social Function Fee R 800
 
             
TRANSPORTATION      
Arrival Details R 180
Arrival Date:
Arrival Time:
Flight Number:
Hotel Name:
Number of persons:
Departure Details R 180
Departure Date:
Departure Time:
Flight Number:
Number of persons:
       
 
TOTAL REGISTRATION COSTS
TOTAL 
       
Payment Method

Electronic Transfer
Bank Deposit
Credit Card
 

ACCOMMODATION BOOKING OPTIONS

I require Accommodation I do not require Accommodation
Please note that the accommodation costs do not form part of your registration.
This is for booking purposes only. You will still need to settle your account with the hotel.  
HOTEL Room Type

Room rate per night
Single Double
(1) FIRST CHOICE OF HOTEL:
Westin Grand Superior R 2 095 R 2 280
Deluxe R 2 365 R 2 540
City Lodge Standard R 1 050 R 1 400
       
(2) SECOND CHOICE OF HOTEL:  
     
  Please select your check in and check out dates:
  Check in     Check out  
Friday 14 November Saturday 15 November Sunday 16 November Monday 17 November
Tuesday 18 November Wednesday 19 November Thursday 20 November Friday 21 November