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16TH SOUTH AFRICAN PSYCHOLOGY CONGRESS - 3rd to 6th AUGUST 2010

INTERNATIONAL CONVENTION CENTRE, DURBAN

REGISTRATION FORM



To be completed by all participants (Including presenters, media, guests and trade delegates)
20 CP Points

PsySSA MEMBERSHIP NO :
HPCSA REG NO :
TITLE :
INITIALS :
FIRSTNAME :
SURNAME :
INSTITUTION :
POSTAL ADDRESS :
WORK TEL :
WORK FAX :
HOME TEL :
HOME FAX :
CELL NO :
EMAIL :
FIELDS OF INTEREST :



PAYMENT OPTION (1): Direct Bank Deposit

ABSA Rosebank (Code: 630-805)
Current Account No: 40-4940-7045 (fax deposit slip)
PAYMENT OPTION (2): Please Indicate Card Type:     Visa Mastercard

CreditCardNumber :
Expiry :
CVC :
Card Holders Name :


CONDITIONS

1. Bank and administration charges incurred (e.g. returned cheque, card authorization refusal) are for the participant's account.

2. A fully completed and signed registration form guarantees registration, confirms participant's attendance and acceptance of registration conditions.

3. Only the above-mentioned methods of payment will be accepted.

4. Written applications for cancellation received before 1 March 2010 will be entitled to a 50% refund; thereafter no refunds shall be made.

5. All conference venues will be on a first come first serve bases. Kindly attend alternate sessions if a venue is fully occupied.



  1 June Early Bird Late/Site Add on
1. PsySSA Member R2150   R2750  
2. Non Member applying for Membership R2900   R3300  
3. Non member R4300   R4800  
4. One Day Fee R2500   R3000  
5. Student Member R1200   R1400  
6. Intern Member R1400   R1600  
7. Student applying for Membership R1400   R1600  
8. Intern applying for Membership R2200   R2400  
9. Foreign Member (20% discount for developing country participants) $500    $550   
10. Foreign Fee $700    $750   


NB: Kindly note that PsySSA Membership runs from January to December. Please be advised that membership in arrears at the end of March will be liable for the re-enrolment fee. Members in arrears at the end of June will be dropped from membership.





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