1 REGISTRATION FORM Conference Secretariat Tel.: +27 21 836 8315 Fax: + 27 086 565 8914 E-mail: [email protected] Postal Address: PO Box 1092 Greenpoint 8015 Cape Town, South Africa 14 – 16 October 2015 The Hilton Sandton, Gauteng 1. DELEGATE REGISTRATION DETAILS Title Name Dr Prof Mr Ms Surname Organisation Postal Address City Country Postal Code Telephone Fax Mobile Email Address 2. PARTICIPANT REGISTRATION FEES (In South African Rands ZAR) CONFERENCE Early Registration Fee paid BEFORE DATE 11 September 2015 Late Registration Fee paid AFTER DATE 11 September 2015 SAMEA Member R 3 450.00 R 4 350.00 SAMEA Non Member R 3 800.00 R 4 750.00 Student R 2 000.00 R 2 400.00 Day Registration rate R 2 000.00 R 2 000.00 TOTAL: CONFERENCE (Please insert amount) TOTAL AMOUNT DUE ZAR: SAMEA Membership Number: Payment: Registration Fees will be charged in full from credit cards at the time of receiving your registration form. Cancellation Fee: 70% of registration fees refunded if cancellation received in writing before 11 September 2015, thereafter 100% cancellation fee Group Registrations: 1 X registration form for each active participant must still be completed and all sent together on one email to the organizers 10% discount applicable & to be calculated on the relevant fees per individual person that forms part of the group Membership: PLEASE NOTE THAT SAMEA NON MEMBERS RECEIVE A COMPLIMENTARY, NON- DEDUCTABLE, SAMEA MEMBERSHIP FOR A PERIOD OF ONE YEAR AT NO ADDITIONAL COST. 3. SECTOR INFORMATION - Please indicate with a Academic Research / University Consultancy NGO Government International If you selected Government please complete this information: Name of Head of Finance: …………………………………………………………………….………………………………… Head of Finance/ Telephone No.: …………………………………………………………………………………………… Head of Finance Email Address: ……………………………………………………………………………………………… 5. DIETARY REQUIREMENTS - Please indicate with a None: Vegetarian: Halaal: Diabetic: Other: 2 6. ACCOMMODATION The Hilton Sandton 5* Single: R1 850.00 per night Double: R 2 250.00 per night The Courtyard Hotel Sandton 4* Single: R 1 250.00 per night Double: R 1 400.00 per night Check In Date: Check Out Date: Total Accommodation: Nights x P/Night = R Special Requirements: 7: PRIVATE AIRPORT TRANSFERS Airport Transfer not required Arrival Transfer R395(Per person One Way) Departure Transfer R395(Per person One Way) Flight Information Arrival Details: Flight: Flight: Flight Arrival Time Flight Departure Time: Transfer to: Transfer From: 8. PAYMENT - Please indicate with a your preferred payment method for the Conference & Workshop Fees PAYMENT METHOD Bank transfer before 11 September Government Order before 11 September Bank transfer after 11 September Government Order after 11 September Credit Card before 11 September CASH Payment ONSITE Credit Card after 11 September CREDIT CARD DETAILS – YOUR CREDIT CARD WILL be CHARGED AT THE TIME OF RECEIVING YOUR REGISTRATION FORM FOR ALL REGISTRATION FEES DUE. Card Type (Visa, Mastercard, Diners, Amex) Card Number Expiry Date (month and year) Last 3 digits on back of card 9. SIGNATURE AS CONFIRMATION AND AGREEMENT TO PAYMENT TERMS AND CONDITIONS LISTED HEREIN PLEASE NOTE THAT BY SIGNING THIS DOCUMENT, ALL SAMEA MEMBERS AND CONFERENCE PARTICIPANTS, DECLARE TO HAVE READ, UNDERSTOOD AND AGREE TO ADHERE TO THE STANDARDS OF QUALITY, ETHICS AND VALUES IN EVALUATION SET BY THE AFRICAN EVALUATION GUIDELINES. Please Click HERE to download the Guidelines. Signature: Date: Details for EFT / Bank Transfer Payments Bank Account Details Account Name SAMEA Conference Account Number 4080650451 Bank ABSA Bank Branch Code 632005 Reference Use Initial and Surname as reference e.g. J. Blogg Branch Claremont Please fax proof of EFT/bank transfer payments to SAMEA Conference Organiser on 086 565 8914 or email proof to [email protected] GENERAL INFORMATION WITH REGARD TO REGISTRATION Pre Conference Workshop Registration will open Pre- Conference Workshops: will run from Monday 12 October – Wednesday 14 October 2015 (ending at lunchtime). Onsite Registration for the Conference and Workshops will open at 09h00 on Monday 12 October 2015. REGISTRATION Please complete the registration form and return via the online method or via email or fax to: Fazlin Anthony, Registration Services Email: [email protected] Fax: 086 565 8914 Tel.: 021 836 8315 REGISTRATION & PAYMENT DEADLINE Online registration closes on 05 October 2015. Thereafter only cash / credit card onsite registrations will be accommodated, with ‘no frills’ 3 REGISTRATION FEE The registration fee includes: Entrance to conference sessions from opening plenary after lunch on 14 October to 16 October 2015, including registration pack. Note: Lunch on the 14th October is NOT included unless you are attending a pre-conference workshop on the 12th October 2015 Lunch and tea for the duration of the conference. PAYMENT OF REGISTRATION FEE To qualify for the early registration fee, please ensure payment is received on or before 11 Sept 2015. Thereafter the higher/late registration fee will apply. Payment will automatically be charged for Credit Card payments at the time of registration. If you are paying by bank transfer/EFT, please ensure payment is received by the early bird registration deadline date in order to receive this discount. If payment is received AFTER 11 Sept 2015, the late registration fee will apply. IMPORTANT NOTE FOR GOVERNMENT OFFICIALS (with regards to payment) Your registration is NOT confirmed and entrance will NOT be permitted unless we receive full prepayment or a copy of a government order in advance of 05 October 2015. If you intend registering onsite on the day: you will only be accepted if you pay in cash at the rate of R2 000.00 per day or a Government Order would also need to be made out in the amount of R 2 000 per day if registering onsite IMPORTANT NOTE FOR OTHER PARTICIPANTS (with regards to payment) Your registration is only confirmed and entrance is only permitted if prepayment is received prior to the start of the conference or if you make payment onsite at registration. CANCELLATION CHARGES 70% of registration fees refunded if cancellation is received in writing before 11 September 2015. Thereafter 100% cancellation will be charged. ACCOMMODATION TERMS & CONDITIONS Upon booking, full payment is required to secure your accommodation. Please be advised that these special rates has been negotiated for the conference period only CANCELLATION POLICY Should you wish to cancel before 25 August 2015, a refund of 70% will be refunded. The 30% will be to cover all administration costs. After the 25 August 2015, 100% cancellation will apply GAUTRAIN The Hilton Sandton is located 1 kilometre from the Gautrain. The Venue offers a complimentary shuttle service from the Gautrain to the conference venue. PRIVATE AIRPORT TRANSFERS (For your own account) Transport from O.R. Tambo International Airport to your hotel and back again is for your own account. An official transport company has been contracted and who will be at the DOMESTIC ARRIVALS HALL (outside the luggage collection area) carrying signage with the wording SAMEA CONFERENCE. You will be assisted on arrival by this company and will need to make cash payment directly to them. Cost: R395.00 PER PERSON (per person One Way) Please ensure you are carrying the correct amount of cash with you to make payment on arrival and to utilise this service. TRANSPORT TO AND FROM THE CONFERENCE VENUE EACH DAY No Official transport has been arranged. Transport between other hotels and the conference venue will be for your own account and arrangement.
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