Registration CIAA 2001
University of Pretoria, July 23-25, 2001
Full name:
Affiliation:
Address:
City: State/Province:
Postal Code: Country:
Phone: Fax:
E-mail Address:
Number of Extra Dinner Tickets (ZAR 200 per ticket):
Signature:

 

Amount Payable:

Conference Fee:
-If payment is received by 31 May: ZAR 1 250   
-Payment due after 31 May: ZAR 1 500

Extra Dinner Tickets:      R ______________

TOTAL AMOUNT DUE: R_______________

For payment by credit card:
VISA # Expiry date:
MC # Expiry date:

For payment by bank transfer:

Bank
Cheque Account No of the University of Pretoria
Sort code
Swiftaddress
Reference number

: ABSA bank Hatfield
: 214 0000 038
: 33 55 45 15
: ABSAZAJJCPT
: cost code A7582-3545

Fax together with credit card information OR bank-transfer receipt to:

Department of Computer Science
University of Pretoria
FAX: +27-12-362-5188