WOMEN EMPOWERMENT CONFERENCE REGISTRATION FORM DELEGATE INFORMATION Title : First name: Surname: Preferred name on name tag (if different to above): Institution/organisation: Industry sector: CONTACT INFORMATION Postal address: Telephone number: Facsimile number: Mobile number: Email address: DIETARY INFORMATION
REGISTRATION FEES The conference costs R100 per person and includes access to all sessions:
16 August 2012 – Conference (8h00) & Gala dinner at International Convention Centre (ICC) - 18h00 17 August 2012 – Conference/Excursion (8h00 – 16h00)
Please note the conference is only open to women owned business over one year old.
PAYMENT DETAILS
Payment can be made by direct deposit or EFT only. Please make sure you reference is your initial and surname. We regret we will not accept cheques or credit card payments.
Bank Account Name Account number Account held Branch code Reference
:Standard Bank :ETK Electronic :050134116 :Kingsmead :040 026 :200 9360 7207
Please drop all the registration forms at 75 Dr Langalibalele Street (Winder Street), 11th floor or fax: 086 721 7108 RSVP deadlines: 3 August 2012
Contact details: Hlengiwe Mthethwa Tel: 031 311 4578, mthethwah@durban.gov.za Nondumiso Mhlongo Tel: 031 261 5585, mhlongonondumiso@durban.gov.za