HERS-SA mini-ACADEMY 2012

Sunday 15 – Wednesday 18 April 2012
Upper East Side Hotel, Woodstock, Cape Town

 

HERS-SA mini-ACADEMY 2012
APPLICATION FORM

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

I would like to apply to attend the HERS-SA mini-ACADEMY 2012 from Sunday 15 – Wednesday 18 April 2012.  I understand that applications will only be accepted from HERS-SA ACADEMY alumnae and on a first-come first-served basis.   Places will only be confirmed once the mini-ACADEMY fee of R6000 + 14% VAT R840 (Total R6840) 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:

Year applicant attended HERS-SA ACADEMY:  
                                                                                   20 _ _

Institution:

Position:

Department:

Postal Address:

Email address (print clearly):

Telephone: (       )
Cell:

Fax: (         ) 

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

Signature of applicant:

By 29 February 2012

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

EMAIL:  hers@chec.ac.za     FAX:  +27-(0)21-763-7117
POST:   HERS-SA, PO BOX 24022, CLAREMONT, 7735, SOUTH AFRICA

Enquiries:  hers@chec.ac.za