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Hellenic Students Association of Cape Town NAHYSOSA Affiliate HSA WEEKEND AWAY 2015 APPLICATION FORM
Saldanha bay (12th to 14th of June 2015)
PERSONAL DETAILS
MEDICAL AID DETAILS
First Name:
________________________________
Medical Aid:
Surname:
________________________________
Medical Aid #: _______________________________
ID Number:
________________________________
Main Member: _______________________________
Date of Birth:
_______/_______/_______
ID Number:
Are you a member of HSA Cape Town?
(Yes/No)
_______________________________
_______________________________
Contact Number:
(____)___________________
Contact # of Doctor:
(____)___________________
PACKAGE DETAILS
CONTACT DETAILS
Phone Numbers:
The package will run from Friday June 12th to
Home: (____)___________________
Sunday June 14th.
Cell:
(from Friday supper until Sunday breakfast)
COSTS
(____)___________________
E-mail: ______________________________________
The cost includes accommodation, dinner on Friday
In case of emergency, call:
and Saturday nights, breakfast on Saturday and
Name: ______________________________________
Sunday mornings. Lunch is EXCLUDED from the price
Cell:
(so please bring extra money for lunch).
(____)___________________
Members of HSA/other affiliate:R650
GENERAL DETAILS
Non-Members: R700
THINGS TO BRING
Please specify any dietary requirements:
_____________________________________________
•
Money for lunch
_____________________________________________
•
Snacks, iPods, chargers
_____________________________________________
•
Own alcohol
•
Toiletries
•
Beach stuff
•
Yourselves
Please specify any allergies or medical requirements:
_____________________________________________
_____________________________________________
_____________________________________________
For enquiries regarding HSA Weekend Away 2015
please contact:
Angeliki Vayanos:
073 321 2012
Peter Stavrinou:
082 458 3448
NAHYSOSA AFFILIATES: BHYA (Bloemfontein); ECHYA (Port Elizabeth); HCYA (Johannesburg); HSA (Cape Town); HSA (Rhodes); PHYC (Pretoria); SHA (Johannesburg); SYHS (Durban); UJHA (Johannesburg) Hellenic Students Association of Cape Town NAHYSOSA Affiliate TAKE NOTE
As there is limited space for the HSA Weekend Away – a
first come first serve mechanism will be enforced.
If cancellation is made 2 weeks prior to the start of
Weekend Away, a cancellation fee of 50% of Weekend
Away Cost is incurred.
Members will have first option, and as such will have
If cancellation is made within 1 week of the start of
Weekend Away, a cancellation fee of 100% of
exclusive access to the application process until May
Weekend Away Cost is incurred.
15
th
2015, thereafter, non-members may apply. All
DISCLAIMER
applications must be submitted and paid for in full by
Monday, 25th May 2015.
This section is to be completed by ALL applicants. If
the applicant is under the age of 18, a legal guardian
Any application submitted without a copy of your
must act on their behalf.
deposit slip will be declined until such time that the
I, ____________________________________, being
deposit slip is provided. Any damages or breakages
the applicant’s parent / guardian / applicant, hereby
caused by the participant will be for his or her personal
certify that all the above information is true and
account and will need to be settled immediately at his
correct. I have read all the contents and conditions of
or her own expense. NAHYSOSA HSA CT will not
the HSA Weekend Away 2015, hosted by NAHYSOSA
tolerate unruly and disturbing behaviour and reserves
HSA Cape Town, and hereby give consent for
the right to ask participants to leave the HSA Weekend
____________________________________________
Away on account of inappropriate behaviour.
(Applicants full name and surname), to participate in
the HSA Weekend Away 2015. I further certify that I
PAYMENT DETAILS
Payment of the full amount must accompany this
application form. A copy of the deposit slip / transfer
slip should be faxed or emailed together with this form.
BANKING DETAILS
will
not
hold
HSA
Cape
Town
or
any
of
its
representatives liable for any harm, injury, accident,
illness, death or damages incurred by / to the applicant
during the HSA Weekend Away 2015. I hold myself
bound to any expense or conditions incurred as a
result thereof. I further indemnify HSA Cape Town and
any of its representatives against any loss in respect to
Bank:
First National Bank
baggage or personal items lost for the duration of the
Name:
Hellenic Youth of Cape Town
HSA Weekend Away 2015 thereof.
Account #:
622 833 50 777
Date:
_______/_______/_______
Branch:
Sea Point, Cape Town
Signature:
_______________________
Branch Code:
201809
Reference:
“WA” + Surname, Initial
CANCELLATION POLICY
If cancellation is made 1 month prior to the start of
Weekend Away, a cancellation fee of 25% of Weekend
Away Cost is incurred.
(Legal Guardian if under 18 years)
Please email the forms to the following
email address:
[email protected]
And confirm that everything has been
received by
Monday, May 25th
2015.
NAHYSOSA AFFILIATES: BHYA (Bloemfontein); ECHYA (Port Elizabeth); HCYA (Johannesburg); HSA (Cape Town); HSA (Rhodes); PHYC (Pretoria); SHA (Johannesburg); SYHS (Durban); UJHA (Johannesburg) Hellenic Students Association of Cape Town NAHYSOSA Affiliate Out of town applicants:
If you do not live in Cape Town and are planning on travelling to Cape Town for this event, please
fill in the relevant information below:
*Please note the venue is a 2 hour drive out of Cape Town so bear that in mind when booking
flights on the Friday afternoon. In terms of your departure time, we will have to drive back to Cape
Town to take to the airport so evening flights on the Sunday are a better option. There will be
space with all of our committee members to get you from the airport to the destination for
Weekend Away 2015.
Travelling from: (please state city)
Please circle the method of transport you will be using to get to Cape Town:
I will be arriving by car/aeroplane.
•
If by car:
Estimated time of arrival:
•
If by aeroplane:
Arrival time and date:
Departure time and date:
Please do not hesitate to contact us for assistance with flight times and airport pick ups. Between
Peter and Angeliki, we will be able to fetch and take to the airport when needed.
Angeliki Vayanos: 073 321 2012
Or Peter Stavrinou: 082 458 3448
NAHYSOSA AFFILIATES: BHYA (Bloemfontein); ECHYA (Port Elizabeth); HCYA (Johannesburg); HSA (Cape Town); HSA (Rhodes); PHYC (Pretoria); SHA (Johannesburg); SYHS (Durban); UJHA (Johannesburg)