HPBASA
  Home about us doctors corner contact us
Doctors Corner
Website Sponsored by

REGISTRATION FORM

HPBASA SPRING UPDATE : 9 – 10 October 2010

Personal Details

Title:
Initials:
Surname: *
First name or Preferred name (for name badge) *
Postal Address:
 
Code:
Telephone (H): *
Telephone (w):
Fax:
Cell number: *
Email: *
MP Number:

Registration Fee :

Member of HPBASA R1 500.00
Non Member Surgeon R1 750.00
Registrars/Technicians/Nurses R 500.00
   
Total
   

Method of Payment

Bank deposit or EFT:
Credit Card:

NOTE : 15% of the registration fee will be forfeited on cancellations received before 30 September 2010.
NO REFUNDS will be made after this date.


 

 

 

A Click here to visit the E2 website