2017 Annual Conference Registration

  Jurisdiction (if applicable):
  Postal Address (required):
  City (required):
  Country (required):
  Postal Code (required):
  Telephone No. (required):
  Facsimile No. (required):
  E-Mail (required):
  Conference Registration: Attendee No. 1
  Title (required):   Other:
  Surname (required):
  First Name (required):
  Organisation (required):
  Position (required):
  E-Mail (required):
  Golf-Shirt Size (required):
  Dietry Requirements (required):   Other:
  Conference Registration: Attendee No. 2
  Title:   Other:
  Surname:
  First Name:
  Organisation:
  Position:
  E-Mail:
  Golf-Shirt Size:
  Dietry Requirements:   Other:
  Conference Registration: Attendee No. 3
  Title:   Other:
  Surname:
  First Name:
  Organisation:
  Position:
  E-Mail:
  Golf-Shirt Size:
  Dietry Requirements:   Other:
  Conference Registration: Attendee No. 4
  Title:   Other:
  Surname:
  First Name:
  Organisation:
  Position:
  E-Mail:
  Golf-Shirt Size:
  Dietry Requirements:   Other:
  Conference Registration: Attendee No. 5
  Title:   Other:
  Surname:
  First Name:
  Organisation:
  Position:
  E-Mail:
  Golf-Shirt Size:
  Dietry Requirements:   Other:
  Conference Registration Fee per person: USD200.00
  PLEASE NOTE ONLY EFT PAYMENTS ARE ACCEPTED
Account name: GRAF
Account number: 331 533 901
Bank: Standard Bank
Branch: Polokwane Square
Branch code: 052 548 00
Account Type: Cheque Account
Swift code: SBZA ZA JJ
Reference: G15 Jurisdictional/Institution Name
  Please email proof of payment to Kotzea@lgb.co.za or fax to 086 505 3460
  Deadline for Registration: TO BE CONFIRMED