2018 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: USD250.00 (members)
	Conference Registration Fee per person: USD300.00 (non-members)
	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