KMC Workshop – Registration Workshop Registration - KMC Workshop - 2018 Step 1 of 7 0% Delegate Type*Full DelegateDay DelegatePlease note that fields marked with a red asterisk are mandatory entry/selection items and must be completed for your registration to be successful. Upon completion of your registration you will receive an e-mail confirming your information. An invoice for your registration will accompany the e-mail as a PDF attachment. Registration closes on 24 February 2018, or when the workshop is full, whichever happens first. Personal InformationTitle*MsMrsMrDrProfName* First Last Name on badgeName to appear on badge - Please specify your first name or name used and surname ONLY.Gender*MaleFemaleDietary Requirements - Full DelegatesNOTE: All meals are served as a buffet and you will be able to select the foods you eat. Please indicate specific food preferences, e.g. Halaal, vegetarian or other, below. Kindly complete your own registration form and list your dietary requirements (if applicable). Dietary Requirements - Full Delegates*Dietary Requirements - NoneDietary Requirements - VegetarianDietary Requirements - Halaal - R1340 one-off feeDietary Requirements - Other - please specify belowHalaal Meals - R1340 one-off fee for full delegates Family/accompanying person: Please contact firstname.lastname@example.org for rates for non-workshop attending people.Other/additional dietary requirementsContact InformationPlease ensure that the contact details given below are accurate to ensure that the workshop organisers can get in touch with you should the need arise.Cell Number*Phone Number*Fax NumberEmail Address* Institution*VAT numberEnter the paying institution VAT number if required for invoicing.Address*Please supply a full postal address, including the postal code, as required for invoicing purposes. Postal Address City County / State / Province ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe CPD CertificationDelegate badges will be scanned daily at registration desk CPD/attendance purposes. CPD certificates will be printed with the badge name specified on this registration form.CPD Certificate*NoYesI require a CPD/attendance certificate (will be printed with name as supplied on this registration form) will be e-mailed to you, please make sure that you have supplied a valid e-mail address and registration number. No registration number provided below = no CPD certificate.MP/relevant number* Note: CPD certificates can only be provided for delegates who provide the relevant registration number. Will you be flying to the workshop?*Not FlyingFlying to Durban (KSI)Flying to Johannesburg (ORT)Please indicate whether you will be flying or not, so we may capture additional detailsFlying DelegatesFlight details and airport bus details are only required for delegates flying in. Please take note: Take careful note of the bus departure times listed below. Ensure that your flight arrangements (where applicable) allow sufficient time for you to meet the bus prior to departure. Transfer from & to 11 March 2018 13 March 2018 OR Tambo International (Johannesburg) R1300 per person (single or return) Departure from airport: 10h00 Estimated travel time 4-5+ hours. Departure from venue: 13h00 Estimated travel time 4-5+ hours. King Shaka International (Durban) R950 (single or return, min 41 people) Departure from airport: 11h00 Estimated travel time 3-4+ hours. Departure from venue: 13h00 Estimated travel time 3-4+ hours. Airport bus leaves at specified time only (one transfer per airport), please book your flights accordingly especially your return flights on 13 March or arrange your own transport to and from the venue. No lunch at the venue on 11 March so please eat/buy at the airport. Workshop starts at 15h30 with tea on 11/3 and ends after lunch at 13h00 on 13/3Inbound flightFlight details for your arrival on 11 March 2018Flight Number*Please mark as "UNKNOWN" or "PENDING" if you have not booked your flights yet.Arrival Time : HH MM Time in 24 hour format pleaseOutbound flightFlight details for your departure on 13 March 2018Flight Number*Please mark as "UNKNOWN" or "PENDING" if you have not booked your flights yet.Departure Time : HH MM Time in 24 hour format pleaseAirport TransfersBus to/from airport*No bus transport requiredJohannesburg (Single or return - same price) - R1300Durban (Single or return - same price) - R950Do you require bus transport between your inbound and outbound airport and the workshop venue? R1300.00 Single or return from Johannesburg R950.00 Single or return from DurbanRegistration and AccommodationCheck-in time: 15h00, registration starts at 14h00 and workshop starts at 16h30. Family/accompanying person: Please contact email@example.com for rates for non-workshop attending people.Accommodation Option*SINGLE accommodation in hotel room with en-suite bathroom - R5600 per personSHARING accommodation in one-bedroom hotel room with en-suite bathroom - R4600 per personSHARING accommodation in two-bedroom hotel family room (Sharing bathroom, own bedroom) - R4600 per personNote: The rates shown include both workshop registration and accommodation fees and are not applicable to non-workshop attending people. Please contact the organisers for accompanying person rates (people sharing with you but not attending the conference). Accommodation - Further Information - SINGLE accommodation in hotel room with en-suite bathroom. - SHARING accommodation in one-bedroom hotel room with en-suite bathroom: Sharing bedroom and bathroom (own bed). Single beds for non-couple sharing, double beds for couples* - SHARING accommodation in two-bedroom hotel family room: each person has own bedroom but share the bathroom. Lounge and TV in main bedroom (double bed) with balcony and view. Interleading bedrooms. Second smaller bedroom (2 single beds) backs onto passage. (Limited number of family rooms available).Sharing hotel room with*Please supply the name and surname of the person with whom you would prefer to share a hotel room.Sharing hotel family room with*Please supply the name and surname of the person with whom you would prefer to share the hotel family room.Important NoteAn administration fee of R250 will be charged on any refunds - please confirm amounts before making payment. Delegates will not be registered on receipt of orders. An invoice will be issued when an order is received and the delegate(s) will be registered when the invoice is paid. You may deposit cheques directly into the bank account. Online credit card facilities available on Priorities website. Completed registration forms and full payment secure your place at the workshop. Day Delegate OptionsRegistration and AttendancePlease indicate below which date(s) you will be attending the workshop as a Day Delegate. Note that day delegate registration fees quoted below include lunch and tea(s). Day Delegate registration fees Number of daysRegistration fee 1R2300 2R2900 3R3600 Day(s) AttendingHow many days will you be attending in total?*Days Attending - One - R2300Days Attending - Two - R2900Days Attending - Three - R3600Registration and attendance as day delegate (including lunch & tea(s). Please specify attendance dates and food/drink choices belowDietary Requirements - Day DelegatesNOTE: All meals are served as a buffet and you will be able to select the foods you eat. Please indicate specific food preferences, e.g. Halaal, vegetarian or other, below. Kindly complete your own registration form and list your dietary requirements (if applicable). Dietary Requirements - Day Delegates*Dietary Requirements - NoneDietary Requirements - VegetarianDietary Requirements - Halaal - R550 per dayDietary Requirements - Other - please specify belowHalaal Meals - R550 per day surcharge. Applies to lunch and teas per day attending separate from any Halaal meals chosen Family/accompanying person: Please contact firstname.lastname@example.org for rates for non-workshop attending people.Other/additional dietary requirementsDays attending and meal choicesPlease indicate on which date(s) you may be attending and will require breakfast (R145 per person) or dinner including soft drink (R265 per person) or both for R410. Halaal meals are charged at R280 per person for breakfast, R380 for dinner including soft drink, or both for R660.11th March 201811th March 2018 - Attending workshop11th March 2018 - Attendance including dinner11th March 2018 - Not attending on this day12th March 201812th March 2018 - Attending workshop12th March 2018 - Attendance including breakfast12th March 2018 - Attendance including dinner12th March 2018 - Attendance including breakfast and dinner12th March 2018 - Not attending on this day13th March 201813th March 2018 - Attending workshop13th March 2018 - Attendance including breakfast13th March 2018 - Not attending on this dayImportant NoteAn administration fee of R250 will be charged on any refunds - please confirm amounts before making payment. Delegates will not be registered on receipt of orders. An invoice will be issued when an order is received and the delegate(s) will be registered when the invoice is paid. You may deposit cheques directly into the bank account. Online credit card facilities available on Priorities website. Completed registration forms and full payment secure your place at the workshop. Registration Form Additional InformationIt would be greatly appreciated if you could complete the following fields to help us with planning the workshop, although it is not mandatory.NameProfessionDesignationWorkplaceExperience with KMCExpectations of the WorkshopWhat contributions would you like to make to the Workshop? Terms and ConditionsAny refunds (duplicate payments, incorrect amount paid, cancellations, etc) will all incur a R250 admin fee. By checking the field below, completing and submitting this form, I indicate that I have read the information in the registration pack and accept the terms set out in the registration pack (especially with reference to cancellations and refunds).I accept the terms and conditions*Yes, I accept the terms and conditions aboveCheck the box to indicate your acceptance of the terms and conditions.Total due R0.00 PhoneThis field is for validation purposes and should be left unchanged.