registration form - SAMEA conference

1
REGISTRATION FORM
Conference Secretariat
Tel.:
+27 21 836 8315
Fax:
+ 27 086 565 8914
E-mail: registration@sameaconference.co.za
Postal Address:
PO Box 1092
Greenpoint
8015
Cape Town,
South Africa
14 – 16 October 2015
The Hilton Sandton, Gauteng
1. DELEGATE REGISTRATION DETAILS
Title
Name
Dr
Prof
Mr
Ms
Surname
Organisation
Postal Address
City
Country
Postal Code
Telephone
Fax
Mobile
Email Address
2. PARTICIPANT REGISTRATION FEES (In South African Rands ZAR) CONFERENCE
Early Registration Fee paid BEFORE DATE
11 September 2015
Late Registration Fee paid AFTER DATE
11 September 2015
SAMEA Member
R 3 450.00
R 4 350.00
SAMEA Non Member
R 3 800.00
R 4 750.00
Student
R 2 000.00
R 2 400.00
Day Registration rate
R 2 000.00
R 2 000.00
TOTAL: CONFERENCE
(Please insert amount)
TOTAL AMOUNT DUE ZAR:
SAMEA Membership Number:
Payment: Registration Fees will be charged in full from credit cards at the time of receiving your registration form.
Cancellation Fee: 70% of registration fees refunded if cancellation received in writing before 11 September 2015, thereafter 100% cancellation fee
Group Registrations: 1 X registration form for each active participant must still be completed and all sent together on one email to the organizers 10% discount
applicable & to be calculated on the relevant fees per individual person that forms part of the group
Membership: PLEASE NOTE THAT SAMEA NON MEMBERS RECEIVE A COMPLIMENTARY, NON- DEDUCTABLE, SAMEA MEMBERSHIP FOR A PERIOD OF ONE YEAR AT
NO ADDITIONAL COST.
3. SECTOR INFORMATION - Please indicate with a 
Academic
Research /
University
Consultancy
NGO
Government
International
If you selected Government please complete this information:
Name of Head of Finance: …………………………………………………………………….…………………………………
Head of Finance/ Telephone No.: ……………………………………………………………………………………………
Head of Finance Email Address: ………………………………………………………………………………………………
5. DIETARY REQUIREMENTS - Please indicate with a 
None:
Vegetarian:
Halaal:
Diabetic:
Other:
2
6. ACCOMMODATION
The Hilton Sandton 5*
Single: R1 850.00 per night
Double: R 2 250.00 per night
The Courtyard Hotel Sandton 4*
Single: R 1 250.00 per night
Double: R 1 400.00 per night
Check In Date:
Check Out Date:
Total Accommodation:
Nights x
P/Night = R
Special Requirements:
7: PRIVATE AIRPORT TRANSFERS
Airport Transfer not required
Arrival Transfer
R395(Per person One Way)
Departure Transfer
R395(Per person One Way)
Flight Information
Arrival Details:
Flight:
Flight:
Flight Arrival Time
Flight Departure Time:
Transfer to:
Transfer From:
8. PAYMENT - Please indicate with a  your preferred payment method for the Conference & Workshop Fees
PAYMENT METHOD
Bank transfer before
11 September
Government Order
before 11 September
Bank transfer after
11 September
Government Order after 11
September
Credit Card
before 11 September
CASH Payment
ONSITE
Credit Card
after 11 September
CREDIT CARD DETAILS – YOUR CREDIT CARD WILL be CHARGED AT THE TIME OF RECEIVING YOUR REGISTRATION FORM FOR ALL REGISTRATION FEES DUE.
Card Type (Visa, Mastercard, Diners, Amex)
Card Number
Expiry Date (month and year)
Last 3 digits on back of card
9. SIGNATURE AS CONFIRMATION AND AGREEMENT TO PAYMENT TERMS AND CONDITIONS LISTED HEREIN
PLEASE NOTE THAT BY SIGNING THIS DOCUMENT, ALL SAMEA MEMBERS AND CONFERENCE PARTICIPANTS, DECLARE TO HAVE READ, UNDERSTOOD AND AGREE
TO ADHERE TO THE STANDARDS OF QUALITY, ETHICS AND VALUES IN EVALUATION SET BY THE AFRICAN EVALUATION GUIDELINES.
Please Click HERE to download the Guidelines.
Signature:
Date:
Details for EFT / Bank Transfer Payments
Bank Account Details
Account Name
SAMEA Conference
Account Number
4080650451
Bank
ABSA Bank
Branch Code
632005
Reference
Use Initial and Surname as reference e.g. J. Blogg
Branch
Claremont
Please fax proof of EFT/bank transfer payments to SAMEA Conference Organiser on 086 565 8914 or email proof to
registration@sameaconference.co.za
GENERAL INFORMATION WITH REGARD TO REGISTRATION
Pre Conference Workshop Registration will open
Pre- Conference Workshops: will run from Monday 12 October – Wednesday 14 October 2015 (ending at lunchtime).
Onsite Registration for the Conference and Workshops will open at 09h00 on Monday 12 October 2015.
REGISTRATION
Please complete the registration form and return via the online method or via email or fax to:
Fazlin Anthony, Registration Services
Email:
registration@sameconference.co.za
Fax:
086 565 8914
Tel.:
021 836 8315
REGISTRATION & PAYMENT DEADLINE
Online registration closes on 05 October 2015. Thereafter only cash / credit card onsite registrations will be accommodated, with ‘no frills’
3
REGISTRATION FEE
The registration fee includes:
Entrance to conference sessions from opening plenary after lunch on 14 October to 16 October 2015, including registration pack.
Note: Lunch on the 14th October is NOT included unless you are attending a pre-conference workshop on the 12th October 2015
Lunch and tea for the duration of the conference.
PAYMENT OF REGISTRATION FEE
To qualify for the early registration fee, please ensure payment is received on or before 11 Sept 2015. Thereafter the higher/late registration fee will apply.
Payment will automatically be charged for Credit Card payments at the time of registration.
If you are paying by bank transfer/EFT, please ensure payment is received by the early bird registration deadline date in order to receive this discount. If payment is
received AFTER 11 Sept 2015, the late registration fee will apply.
IMPORTANT NOTE FOR GOVERNMENT OFFICIALS (with regards to payment)
Your registration is NOT confirmed and entrance will NOT be permitted unless we receive full prepayment or a copy of a government order in advance of 05 October
2015. If you intend registering onsite on the day:

you will only be accepted if you pay in cash at the rate of R2 000.00 per day or a

Government Order would also need to be made out in the amount of R 2 000 per day if registering onsite
IMPORTANT NOTE FOR OTHER PARTICIPANTS (with regards to payment)
Your registration is only confirmed and entrance is only permitted if prepayment is received prior to the start of the conference or if you make payment onsite at
registration.
CANCELLATION CHARGES
70% of registration fees refunded if cancellation is received in writing before 11 September 2015. Thereafter 100% cancellation will be charged.
ACCOMMODATION TERMS & CONDITIONS
Upon booking, full payment is required to secure your accommodation.
Please be advised that these special rates has been negotiated for the conference period only
CANCELLATION POLICY
Should you wish to cancel before 25 August 2015, a refund of 70% will be refunded.
The 30% will be to cover all administration costs.
After the 25 August 2015, 100% cancellation will apply
GAUTRAIN
The Hilton Sandton is located 1 kilometre from the Gautrain. The Venue offers a complimentary shuttle service from the Gautrain to the conference venue.
PRIVATE AIRPORT TRANSFERS (For your own account)
Transport from O.R. Tambo International Airport to your hotel and back again is for your own account. An official transport company has been contracted and who
will be at the DOMESTIC ARRIVALS HALL (outside the luggage collection area) carrying signage with the wording SAMEA CONFERENCE. You will be assisted on arrival
by this company and will need to make cash payment directly to them.
Cost: R395.00 PER PERSON (per person One Way)
Please ensure you are carrying the correct amount of cash with you to make payment on arrival and to utilise this service.
TRANSPORT TO AND FROM THE CONFERENCE VENUE EACH DAY
No Official transport has been arranged. Transport between other hotels and the conference venue will be for your own account and arrangement.