Depasa Conference Registration Form

DEPASA CONFERENCE 2019 Registration Form “Doing the Right Thing on a Difficult Day” Date: Venue: Cost:

17 – 18 May 2019 Witwatersrand University Centre for Deaf Studies 1 Jan Smuts Avenue, Braamfontein 2000, Johannesburg R1900 per delegate

Please note that accommodation and transport are NOT included

BANKING DETAILS Name: Bank: Account: Amount:

DEPASA First National Bank 62718308746 R1900

Email Completed Forms to finance@delabatskool.co.za Please email all completed forms with proof of payment to: Adriana Van Zyl (De La Bat School) finance@delabatskool.co.za

Registration Form Please enter your details in the space provided. All fields need to be completed School Details School Name Address Postcode Tel Fax Email

Delegate Details Name and

Position

T-shirt size

Position

T-shirt size

Position

T-shirt size

Position

T-shirt size

Surname Name and Surname Name and Surname Name and Surname

Special Requirements Dietary or special needs. Please indicate your preference Halaal

Kosher

Vegetarian

Meat

Comments:

Please sign and confirm that you have read and accepted the Terms and Conditions

Signature:

Date: