Polychar 22: World Forum on Advanced Materials

Polychar 22: World Forum on Advanced Materials
7 April 2014 (Short Course), 8 - 11 April 2014 (Conference)
Stellenbosch, South Africa

Welcome to the POLYCHAR 22 Short Course & Conference Registration.

Please complete the contact information and the applicable registration details below.

Contact Information
Name	# Please provide us with your Name
Surname	# Please provide us with your Surname
Professional Status	#	Student (PhD/MSc/Postdoc)
Affiliation	# Please provide us with your Affiliation
Address	# Please provide us with your Address
City	# Please provide us with your City	Country	# Please provide us with your Country
Code	# Please provide us with your Code	Fax	# Please provide us with your Fax number
Telephone	#	Cellphone	#
E-mail	#	Dietary Requirements i.e. Halaal/Vegetarian	#
# = required field

Submission preference (please tick off):
Keynote Speaker	Invited Speaker	Oral Submission	Poster Submission	Short Course

Academic	Industry Engineer	I apply for Student/Young Researcher prize competition

Young Researcher (postdoc < 35 years)

Registration: Short Course (Monday, 7 April 2014) Free for lecturers
	Description	Before 30 Nov	After 30 Nov
	Students	R1000	R1000
	Regular	R1400	R1400
	Total 1	R

Registration: Conference (8-11 April 2014)
Registration fees include lunch, refreshments, welcoming- and poster sessions:
	Description	Before 30 Nov	After 30 Nov
	Students (banquet excluded)	R2000	R2000
	Regular / Full Participants (banquet included)	R4000	R4500
	Stellenbosch Personnel / Students (banquet excluded)	R2500	R2500
	Young Scientists from Developing Countries (< 32 years) (banquet excluded)	R2500	R2500
	Accompanying Persons (banquet included)	R2500	R3000
	Conference Banquet (transport included)	R500	R500
	Total 2	R

Welcoming- & Poster Session / Conference Banquet
	Description	Number of Persons attending	Amount
	Welcoming/Registration Session: Monday, 7 April 2014, Time: 16:00-18:00, Refreshments will be served		Free of charge
	Poster Sessions: Tuesday, 8 April 2014 & Wednesday, 9 April 2013, Refreshments will be served		Free of charge
	*Conference Banquet (venue will be confirmed): Date: Thursday, 10 April 2014, Time: 19:00
*For regular/full participants: included in registration fee, for spouses: R500 per person

Cancellation Policy

A 50% refund is applicable to cancellations made before 31 January 2014. The Organizing Committee regrets that no refund on cancellation is possible after this date.

Method of Payment

GRAND TOTAL (1-2)	R
I will pay by credit card (Master or Visa)
Please complete credit card authorization form and fax it to: +27(21) 808-4967
I have remitted the total amount from my bank
Bank transfer detail: Account name: The Macromolecular Society of SA (MSSA) Account number: 4-1019-0621 Bank/Sorting Code: 632005 Swift Code: ABSAZAJJ Please fax deposit slip to: +27(21) 808-4967

Additional Information

Please send me an invitation letter

Flight / Accommodation Detail

Arrival Date		Name of Accommodation
Departure Date

For further information contact Aneli Fourie: Conference Secretary
Tel: +27(21)808-3174; Fax: +27(21) 808-4967; Email: aef2@sun.ac.za

Contact Information

Submission preference (please tick off):

Select the session