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REGISTRATION

Option 1:  Fax or Email

PDF  Click here to download the registration form
Fax the registration form to Fax: +27 (0) 11 442-8094
or E-mail: jan.suemc@tiscali.co.za

 

Option 2:  Online Registration

PERSONAL DETAILS: * = Required
* Title  Required 
* First Name  Required 
* Surname / Family Name  Required 
  Telephone
  Fax
* Mobile  Required 
* Email  Required  Invalid format 
* Confirm email  Required  Invalid format 
  Postal Address
  Postal Code
 Hospital/Company/Organisation
  HPCSA/ MP No
  Dietary requirements
Vegetarian

 

COURSE WORKSHOPS - 9 February 2010
BOOKING ESSENTIAL
Paediatric & Neonatal Ventilation (Full day) Tuesday 9 February   R825
Acute Abdominal Emergencies in Children (Half day - morning)   R550
ADHD Symposium (Half day - morning)   R550

 

PAEDIATRIC REFRESHER COURSE:  10 – 12 February 2010
  Early Registration
up to & including 11 Dec 2009		 Late Registration
before 28 Jan 2010
Delegate Registration Fee R2000    R2200
Limited capacity - BOOK EARLY    

 

PAYMENT INSTRUCTIONS

NOTE: If registering as a group, EACH PERSON must complete a separate form. Only full pre-paid registrations will be accepted by the organisers. Bookings are non-transferable.

METHODS OF PAYMENT:
Please fax through proof of payment, with your name and Registration Form, to 011 442 8094. Should this not be received, your booking will be invalid. Please select your method of payment below:
    Bank deposit or electronic transfer:

Account Name: SUE MCGUINNESS COMMUNICATIONS CC – PAEDRC10
Standard Bank Account Number: 202268934
Branch Code: 00 4205

Please print clearly your SURNAME and INITIAL on Bank/Electronic transfers. The Organiser will not be responsible for identifying funds if the delegate’s name is not mentioned. The Organiser will not accept any bank charges associated with the transfer.

 

    Credit Card:

The cardholder must complete and sign this form authorising Sue McGuinness Communications

on behalf of Paediatric Refresher Course 2010 to debit his/her credit card.

For security reasons, please fax or email the form together with:

  1. a photocopy of the front and back of the credit card
  2. the cardholder’s identity document or passport

Fax:  011 442 8094        Email:  jan.suemc@tiscali.co.za

Only Visa and Mastercard accepted.

  

Please check that all *required* fields are completed before submitting.
You will be directed to a confirmation page which you should print out for your records.

 

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