Registration Form

 

  

Johannesburg, South Africa
22 June 2004



All fields are required unless marked with a "*". Name, Title and Company will appear on badge as submitted.

Name

 

Title

 

Company/Affiliation

 

Address

 

Address*

 

City

 

State/Province*

 

Zip/Postal Code

 

Country

 

Telephone

 

Facsimile*

 

E-Mail

 

Registration Fee:

 

ACTE Member R 250
Non-Member R 550
Non-Member Joining R 1 750
Complimentary
       ( If registering as a comp, please include "code")

 

Payment:

 
Check
To pay by check, please do not submit this form on-line. Instead use your browser's print feature to print the completed form, make written note that a check has been mailed, and fax it to Fax +27 11 326-1312. You should also print this form if you require a receipt of registration.



You may submit this form online by Fax +27 11 326-1312 or
Mail: Telsaf Datahouse, Room 215 - 5 Conrad Drive, Blairgowrie, Randburg - Johannesburg, South Africa 2194
You may call T: +27-118866964 for questions or more information.