REGISTRATION FORM
(one per person)
Please type or write clearly in block letters
Name		
Surname		
Professional Status/Title		Student	PhD		MSc		Postdoc		
Affiliation		
Address		
City		Country		Code		
Tel		Fax		
E-mail		Cell		
Dietary Requirements (e.g.. vegetarian / halaal, please specify):		
Accompanying Persons Name		
Submission preference (please tick off √):
Plenary Speaker	Invited Speaker	Oral Submission	Poster Submission	Workshop	Academic	Industry Engineer	
							
Tentative title(s) of Abstract(s)	Exhibitor		

	
REGISTRATION: WORKSHOP (Monday, 7 September 2015)
Free for lecturers
Description	Before 30 Apr 2015	After 30 Apr 2015	
Students	R600	R600	
Regular	R1000	R1000	
	TOTAL 1		
REGISTRATION:  CONFERENCE (8-10 September 2015) 
Registration fees include lunch, refreshments, welcoming- and poster session
Description	Before 30 Apr 2015	After 30 Apr 2015	
Student (banquet not included)	R2500	R2500	
Regular / Full participant (banquet included)	R4500	R5000	
Regular / Full participant (countries from sub-Saharan Africa)	R3500	R4000	
Accompanying Person  (banquet included)	R2500	R2500	
Conference Banquet	R500	R500	
	TOTAL 2		

CONFERENCE DAY DELEGATE REGISTRATION
Description	Date of Attendance	Amount	
Students		R900	
Regular		R1700	
	TOTAL 3		
EXHIBITOR REGISTRATION
Description	Before 30 Apr 2015	After 30 Apr 2015	
2 Delegates full conference registration (banquet included)	R20 000	R20 000	
	TOTAL 4		
WELCOMING- & POSTER SESSION / CONFERENCE BANQUET
Description	Number of Persons Attending	Total Amount	
WELCOMING / REGISTRATION SESSION:  
Monday, 7 September  2015, Time:  16:00 – 18:00, Refreshments will be served 		FREE OF CHARGE	
POSTER SESSION
Tuesday, 8 September  2015, Refreshments will be served		FREE OF CHARGE	
*CONFERENCE BANQUET:  
Date: Wednesday, 9 September 2015, Time:  19:00		R500	
*Included for regular participants and accompanying persons, extra tickets is R500 pp	TOTAL 5		

Method of Payment	GRAND TOTAL (1-5)		
□ I will pay by credit card □ Master or □ Visa
□ I have remitted the above grand total from my bank (fax or e-mail proof of payment)
Additional Information
Please send me an invitation letter:  YES □ NO □ 
Flight / Accommodation Details 
ARRIVAL IN PORT ELIZABETH	DEPARTURE FROM PORT ELIZABETH	
Date	Flight No 	Time 	Name of Accommodation	Date	Flight No	Time	

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

AUTHORISATION FOR PAYMENT BY CREDIT CARD
I hereby authorize that my Credit Card Account be debited in favour of The Macromolecular Society of SA (MSSA) with the amount as indicated hereunder in respect of my enrolment and registration fee for the 13th Annual UNESCO/IUPAC Workshop & Conference on Macromolecules & Materials that will be held in Port Elizabeth, South Africa from 7-10 September 2015.
Name of card holder (Please print clearly):___________________________________
Number of Passport:____________________________________________________	
Credit card number:
																
Expiry date:
		/			
CVC number (last three digits of number on reverse side of the card):
			
Name of card (VISA or MASTER):_______________________________
Amount to be debited against card account:
Currency (£ Sterling / Euro / US $ / Rand ):  ___________________Total:______________
(Office use only:  Forex rate:___________; Project cost number:________________)	
Signature of card holder:_________________________Date:_______/_____/_____
NB!  If you are paying on behalf of a third party, please give the name and contact details of that person:
___________________________________________________________________	
Mail or fax this form together with your registration form to the Conference Secretary:
Attn: Aneli Fourie; Tel:  +27(21) 808-3174, Fax:  +27(21) 808-4967 
E-mail: aef2@sun.ac.za