REGISTRATION FORM
(one per person)
Please type or write clearly in block letters
Name		
Surname		
Professional Status/Title		Student	PhD		MSc		Postdoc		
Affiliation		
Address		
Country		City		Code		
Tel		Fax		
E-mail		Cell		
Dietary Requirements (e.g.. vegetarian / halaal, please specify):		
Accompanying Persons Name		
Submission preference (please tick off √):
Keynote Speaker	Invited Speaker	Oral Submission	Poster Submission	Short Course	Academic	Industry Engineer	
							
Young Researcher (postdoc < 35 years)		I apply for the Student/Young Researcher prize competition		
Select the session:	
Predictive Methods and Simulations		
Surfaces, Interfaces, Adhesion and Tribology		
Polymer Syntheses		
Rheology and Processing		
Mechanical Properties and Performance		
Polymers in Electronics and Optoelectronics		
Nanomaterials and Smart Materials		
Biomaterials and Green Polymers		
Materials for Energy and Recycling		
New Developments Polymer Characterization		
Tentative title(s) of Abstract(s)	

	
Registration: Short Course (Monday, 7 April 2014), Free for lecturers
Description	Before 30 Nov 2013	After 30 Nov 2013	
Students	R1000	R1000	
Regular	R1400	R1400	
	TOTAL 1		

Registration: Conference (8-11 April 2014) 
Registration fees include lunch, refreshments, welcoming- and poster sessions.
Description	Before 30 Nov 2012	After 30 Nov 2012	
Students (banquet excluded)	R2000	R2000	
Regular / Full participants (banquet included)	R4000	R4500	
Stellenbosch University Personnel/Students (banquet excluded)	R2500	R2500	
Young Scientists from Developing Countries(< 32 years) (banquet excluded)	R2500	R3000	
Accompanying Persons (banquet included)	R2500	R3000	
Conference Banquet (transport included)	R500	R500	
	TOTAL 2		
Welcoming- & Poster Session / Conference Banquet
Description	Number of Persons Attending	Total 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 2013 & Wednesday, 9 April 2014 (Times to be confirmed at a later stage), Refreshments will be served		FREE OF CHARGE	
*CONFERENCE BANQUET, VENUE WILL BE CONFIRMED
Date: Thursday, 10 April 2014, Time:  19:00		R500	
*For regular/full participants: included in registration fee;  for spouses: R500 per person	
Flight / Accommodation Details 
ARRIVAL IN CAPE TOWN	DEPARTURE FROM CAPE TOWN	
Date	Flight No 	Time 	Name of Accommodation	Date	Flight No	Time	

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)		

Please complete attached credit card authorization form.
□ I will pay by credit card □ Master or □ Visa.  
□ I have remitted the above grand total from my bank_____________________on Date________________ payable in USD or RAND (copy enclosed) to: 
Account Name: The Macromolecular Society of SA (MSSA)
Address of Bank:  ABSA Bank, Plein Street, Stellenbosch
Account number:  4-1019-0621
Bank / Sorting Code:  632005
Swift Code:  ABSAZAJJ
Signature_____________________________Date_____________________________
This form should be returned (either by fax or e-mail) to the Conference Secretary, Aneli Fourie
Fax:  +27(21) 808-4967, E-mail: aef2@sun.ac.za