Single Registration Form - South Africa

Please read and accept the terms and conditions

Personal information (Single Registration)

Title  
First Name  
Surname  
Organisation  
Position  
Department  
Telephone  
Please enter a valid phone number with integers only
Mobile Number  
Please enter a valid mobile number with integers only
Fax Number  
Please enter a valid fax number with integers only
Email  
Dietary Requirements  
Disability Access  
Please specify what kind of disability access you require e.g. "Wheelchair"
Country  
Province (RSA Only)  
     

Accompanying Person

Do you have an accompanying person?



Company/Organisation Details for Billing Purposes

Billing Name  
Contact Person  
Contact Telephone Number  
Please enter a valid phone number with integers only
Contact Email Address  
Postal Address  
 
Suburb or City  
Country  
Postal Code  
Please enter a valid postal code with integers only
VAT Number  
If your company is VAT exempt, please mark Exempt
Billing Method  


Registration Details

Please carefully select your Membership type to view registration options

SASOP MEMBER

PSYCHIATRIST
Early Bird Rate (8 December 2015 - 30 June 2016) Standard Rate (1 July 2016 – 18 November 2016)
Specialists @ R4 900 Specialists @ R5 600
Registrar @ R4 000 Registrar @ R4 700

NON-SASOP MEMBER

PSYCHIATRIST
Early Bird Rate (8 December 2015 - 30 June 2016) Standard Rate (1 July 2016 – 18 November 2016)
Psychiatrist @ R6 750 Psychiatrist @ R7 500
Registrar @ R5 850 Registrar @ R6 780

NON-PSYCHIATRIST
Early Bird Rate (8 December 2015 - 30 June 2016) Standard Rate (1 July 2016 – 18 November 2016)
General practitioner, Neuroscientist or Neurologist @ R4 100 General practitioner, Neuroscientist or Neurologist @ R4 950
Psychologist @ R3 800 Psychologist @R4 450
Nurse or Neuroscience Postgraduate @ R3 200 Nurse or Neuroscience Postgraduate @ R3 850
Social worker @ R3 200 Social worker @ R3 850
Occupational therapist @ R3 200 Occupational therapist @ R3 850
Physiotherapist @ R3 200 Physiotherapist @ R3 850
Administrator @ R3 200 Administrator @ R3 850

WOULD YOU LIKE TO BECOME A SASOP MEMBER? CLICK HERE FOR MORE INFORMATION



Social Functions

Please indicate if you will be attending the below social functions.

 

Friday, 18 November 2016
Description Delegate Accompanying Person

Congress Opening Ceremony
(17:30 – 18:00)

 Complimentary
 Complimentary
Welcome Cocktail
(19:00 – 21:30) 		Complimentary Complimentary

 

Saturday, 19 November 2016
Description Delegate Accompanying Person
WPA Gala Concert:
(19h00 - 22h00)
Cape Town City Hall @ R320pp		 Attending @ R320pp Accompanying Person @ R320pp

 

Sunday, 20 November 2016 (SASOP MEMBER EVENT)
Description Delegate Accompanying Person

Annual General Meeting
(16h30 - 18h00)

 Yes, I will be attending
 N/A
SASOP members dinner, hosted by the SASOP President
 (19h00 - 22h00)		 Attending @ R500pp Attending @ R500pp

 

Monday, 21 November 2016
Description Delegate Accompanying Person
WPA IC Congress Dinner
Cape Town International Convention Centre (19:00 – 22:00) 		Attending @ R1 150pp Yes, @ R1 150pp

WPA 2016 Congress Terms & Conditions
  1. Payment is due prior to the start of the Congress.
  2. An invoice with the Congress bank details will be sent to you within 72 hours of receipt of you registration. Please make payment on reciept of this invoice.
  3. Receipts will only be issued once proof of payment has been received and once the payment has cleared and been identified in the Congress bank account.
  4. Proof of payment must emailed or faxed to: Stephanie de Boer - [email protected] F: 011 463 3285.
  5. Please ensure that all payments have your unique pin number as per your invoice, in order to trace your payment in our bank account (eg Pin 234).
  6. All payments must be made payable to WPA 2016 Congress.
  7. Registrations are transferable to a delegate who have not yet registered.
  8. Delegates attending from countries outside South Africa are requested to make payment in South African Rands (ZAR) and are responsible to cover the bank charges.  The full delegate registration fee amount invoiced must appear in the Congress bank account.  Should this not be the case, the delegate will need to pay the difference in cash on site before being allowed to participate in the Congress.
  9. No delegates will be allowed entrance to the Congress without payment
 

Cancellations
  1. All cancellations must be received in writing via fax/email to [email protected].
  2. Cancellation received before 21 March 2016 will receive a full refund, less a 10% administration fee.
  3. Cancellation received between 01 April - 15 April 2016 will receive a 50% refund.
  4. No refunds will be issued for invoices raised and cancellation received after 16 April 2016.
  5. Delegates will be liable for invoices issued and failure to cancel prior to 16 April 2016 as well as in the case of non-attendance to the Congress.
  6. All refunds due will only be issued after the Congress.
 

Please make sure of spelling and abbreviations before submitting your form, as this information provided will be published in the delegate book
I accept the terms and conditions of this booking
I grant the organising committee permission to supply my contact details to the trade represented at the conference
I DO NOT grant the organising committee permission to supply my contact details to the trade represented at the conference
 
TOTAL DUE:
Incl14% VAT
R0.00