PROUDLY PRIMARY REGISTRATION

Name of School: *

VAT Registered? *

Postal Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Telephone Number: *

Email: *

Number of Delegates (Cost: R1650 per delegate): *

Includes two evening functions

Number of Delegates (Cost: R1450 per delegate): *

Excludes evening functions

Number of Delegates (Cost: R2450 per delegate): *

Includes two evening functions, plus single accommodation in the Epworth Boarding House

Number of Delegates (Cost: R2350 per delegate): *

Includes two evening functions, plus shared accommodation in the Epworth Boarding House

Number of Delegates (Cost: R3170 per delegate): *

Full registration,including two nights in a single room at Road Lodge on a “first registered and paid basis”

Total

R 0.00

*All accommodation is available on a “First registered and paid” basis

Name of Delegate: *

Title:

Email Address: *

Cellphone Number:

Phase and Grade:

Dietary

Breakway Sessions