Registered Nonprofit Organisation
Registration Number:  027-577-NPO
VAT Registration Number: 4670236902

HERS-SA ACADEMY 2010

APPLICATION FORM

Sunday 12 – Saturday 18 September 2010
University of Cape Town Graduate School of Business, Waterfront, Cape Town

NB:  PLEASE READ THE “APPLICATION PROCESS AND FEES” DOCUMENT
BEFORE COMPLETING THIS FORM  

I would like to apply to attend the HERS-SA ACADEMY 2010 from Sunday 12 September – Saturday 18 September 2010.  I understand that applications will be accepted on a first-come first-served basis, and places will only be confirmed once the ACADEMY fee of R11500 plus 14% VAT R1610 (Total R13110) has been received by HERS-SA. I have obtained the necessary approval from my institution and I have informed the HR/Training and Development Department.   HERS-SA will forward invoices for payment upon receipt of application forms.

PLEASE PRINT:

Family name:

Given names:

Title:

Institution:

Position:

Department:

Postal Address:

Email address (print clearly):

Telephone: (       )
Cell:

Fax: (         ) 

Name as you would like it on your name label:        

Do you have any special needs, e.g. dietary, poor eyesight, hearing impairment, etc? If so please give details:


Signature of applicant:

BY 30 JULY 2010

PLEASE RETURN THIS FORM including signature of applicant BY EMAIL, POST OR FAX TO:

EMAIL: hers@chec.ac.za

POST: HERS-SA, PO BOX 24022, CLAREMONT, 7735, SOUTH AFRICA

FAX:  +27-(0)21-763-7117

Enquiries:  Phyllis Webb, email: hers@chec.ac.za