Measuring Emotions 1 Day Workshop Registration Form ... - Esomar

Measuring Emotions 1 Day Workshop
Registration Form
Fax Back the Registration Form to +27 (0)866 105 124
15 August 2012 at the Rosebank Crowne Plaza
Surname Title
First name
Name to be printed on badge
Company
Position SAMRA member? Yes No
Address
E-­‐mail
Tel. Mobile.
Fax. Other
Special dietary requirements (please tick):
Kosher Halaal Vegan/
Vegetarian
Allergies:
Invoice details
Company name
Postal address
VAT number Order number
Contact person
Tel. number
Fish only None Allergies
(specify)
Banking details: SAMRA, Standard Bank Parktown, account number 200820419,
Branch code 000355
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ESOMAR Workshops 2011 Registration Form

• RECEIVE A 10% DISCOUNT ON THE WORKSHOP RATE IF YOU ARE ALSO BOOKED
FOR THE 2012 SAMRA CONFERENCE.
• COMPANIES WILL RECEIVE A 10% DISCOUNT ON THE WORKSHOP RATE IF THEY
SEND 5 OR MORE DELEGATES TO THE 2012 SAMRA CONFERENCE.
Terms and Conditions:
- Packages given above exclude VAT, chargeable at 14% where relevant
- Bookings are firm.
- Cancellations will NOT be accepted and NO refunds will be made.
- An invoice will be issued on booking, payable on receipt of invoice at the address given under ‘Invoice
details’ above.
- Substitutions will be accepted up until close of business on 10 August 2012
- Access to the workshop is subject to payment received on the above terms.
- Any room service, drinks and incidental expenses charged to rooms, will be for the delegates’ accounts and
will need to be settled by delegates on departure
To Book:
Please tick preferred option: î MEMBER
NON-­‐MEMBER
(excl. VAT)
(excl. VAT)
Full delegate (1 day course, no accommodation)
R 3, 200.00 R 3, 800.00
Workshop only, including lunch
Tick Tick
- Tick your option above and send to Kerry Oliver at 0866 105 124 (fax) or samra@thelime.co.za or visit
www.samra.co.za or call Kerry on 011 467 8998/9233 for any queries.
- Send ONE form per delegate
- Clearly write your invoice number as reference on the deposit slip.
- Send the deposit slip to Kerry on 0866 105 124 (fax) or samra@thelime.co.za
- Bookings close 3 August 2012
Book early!! Only 30 seats available – first come first serve!!!
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ESOMAR Workshops 2011 Registration Form