Register for the 2020 ECSSA Conference
Title:
First Name:
Last Name:
HPCSA (or other) Registration:
Address:
City:
Province:
Postal Code:
Country:
Telephone:
Fax:
E-mail:
Confirm E-mail:
Organisation:
Type of Registration:
Membership: 1 Include 1 Year ECSSA Membership
Events Attending: 2 Cocktails: 9 July (no additional charge)

Additional Guests for Cocktails:
Dietary Requirements:
Shirt Size: 3


Registration Fee: (all inclusive)

Important information:
  • This is the first step of registration and does not, on its own, confer a valid registration to the applicant.
  • Registration will be confirmed by email, to the email address supplied in the application form.
  • The applicable registration fee must be paid using the account information below, and proof of payment submitted to conference@ecssa.org.za.
  • Once proof of payment has been received, active registration will be confirmed by email to the email address supplied in the registration form.
  • Requests for cancellation of registration should be sent in writing to conference@ecssa.org.za. Prior to 9 June 2020, a 10% cancellation fee will apply. After 9 June 2020 a 100% cancellation fee will apply. Refunds will be processed after 9 August 2020.
  • The registration fee must be paid in full into ECSSA's bank account:

      ABSA Bank
      Branch: Davenport (Branch Code: 632005)
      Account Number: 4074446626
      Reference: ECSSA2020 + Surname
Notes:
  • A year's ECSSA membership is included in the conference registration fee. Please check this option if you would like to activate this free memberhsip, or leave the box unchecked if you would like not to.
  • Attendance of cocktails on the evening of 9 July is included in the conference registration fee. Please indicate your attendance for planning purposes. Please note that if you would like to bring a guest to the cocktail function you will be required to indicate this in the form at the left, and an additional charge of R200.00 per guest will be added to your registration fee.
  • An ECSSA conference shirt is included with the conference registration fee.



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