ACCC2014 REGISTRATION FORM	
Biographical details	
Last name		
First name		
Title 		
Organisation		
Department		
Country		
Contact phone		
E-mail address		
Payment Details	
		Amount	
REGISTRATION FEE			
DELEGATE 		ZAR 2500	
			
Non-participating partner(s)		
Gala Dinner (6 November)                   R350			
			
Total		
General	
Special dietary requirements (please specify)

Transportation for the Gala Dinner ONLY. 	Yes		No		

Registration Procedure

1.	Please complete the registration form and e-mail with proof of payment to:  Amber.Share2@nmmu.ac.za 
with the subject line:  ACCC2014 REGISTRATION

2.	If you are unable to e-mail the form, please fax it to:  +27 (0)41 504 3602 /3313 for the attention of Miss Amber Share

3.	Payments are to be transferred electronically as follows:
a.	Bank Name:		Standard Bank
b.	Account name: 		Nelson Mandela Metropolitan University
c.	Account Type: 		Business Current Account
d.	Account Number: 	080 263 011
e.	Branch Name: 		Rink Street
f.	Branch Code: 		050417
Please Note: you MUST use the following as payment reference 3087 ACCC <Delegate Name>

4.	Please inform Amber Share if you require an invoice Amber.Share2@nmmu.ac.za.