Conference Registration Form

LOCATION: COASTLANDS UMHLANGA HOTEL AND CONVENTION CENTRE, DURBAN

REGISTRATION FEES INCLUDE CONFERENCE PACK, REFRESHMENTS, MEALS AND FUNCTIONS BUT EXCLUDES TRAVEL AND ACCOMMODATION COSTS

Please fill in the form below and we will get back to you as soon as possible.

"*" indicates required fields

Are You a Member of IMPSA?*

Yes

IMPSA Membership Number

Title*

Name*

First Last

Institution*

Province

State / Province / Region

Department*

Position*

Email*

Telephone Number

Mobile Number*

Fax Number

Postal Address*

Preferred Name for Nametag*

Gender*

Male

Female

Golf Shirt Size*

Dietary Preference*

Regular

Halaal

Vegetarian

Other

If other, please specify

Special Physical Access Requirements

Will you be attending the Gala Dinner?*

Yes

Rates
Description	Member	Non-Member
Registration	R 5 600.00	R 6 700.00
Spouse/Additional Delegate	R 525.00	R 525.00

Please enter your Grand Total*

Date Form Completed*

I Accept IMPSA Terms & Services

I Accept IMPSA <a href="https://www.impsa.co.za/conference-registration-form/#ts-cs">Terms & Services</a>*

Yes

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Phone

This field is for validation purposes and should be left unchanged.

BOOKINGS WILL ONLY BE RECORDED ON THE NUMERICAL LIST ONCE FULL PAYMENT IS RECEIVED!
PLEASE E–MAIL PROOF OF PAYMENT TO:
Musiiwa Netshimbupfe – conference@impsa.co.za

PAYMENT BY ELECTRONIC TRANSFER TO:
Account Name: IMPSA
Account Number: 4079024463
Bank: ABSA
Branch: 632005

The Institute is a NPO and not VAT registered. Invoices will be furnished upon request

PLEASE NOTE THAT NO DELEGATE WOULD BE REGISTERED AT THE CONFERENCE WITHOUT PROOF OF PAYMENT

Terms and Conditions:
1. Cancellations: Written cancellations prior to 16 October 2024 will be charged at 50% of registration cost. Full fees are payable thereafter. You are however welcome to send a substitute without incurring additional fees.
2. Payment must be made prior to commencement of this event.
3. Confirmation: All registrations will be deemed confirmed and subject to these Terms and Conditions.
4. Substitution is permitted at any time provided the name changes are communicated to the organisers by e–mail.
I hereby acknowledge that I have read and understand the Terms and Conditions as set out above. I am authorized to sign this registration on behalf of my Company/Council and take full responsibility to ensure that the above amounts will be paid in time.
I hereby give permission that my contact details may be shared with Sponsors and Marketers of this event.