Congress Registration Form Please complete one Registration form per Delegate/Exhibitor/Speaker. Section A: Contact Details Designation: Delegate / Exhibitor / Presenter (Free Communication/Oral Presentation/Video) Title: Select Dr Prof Mr Mrs Ms Miss Family Name: First Name: Middle Name: Name for Badge: Organisation/Institution: Speciality: Department: Address: City: State/Province: ZIP/Post Code: Country: Select Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic Cook Islands Costa Rica Côte d'Ivoire (Ivory Coast) Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (north) Korea (south) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Zaire Zambia Zimbabwe Telephone: (Country code/city code/number) Fax: (Country code/city code/number) E-Mail: In case of emergency, please contact: Emergency Telephone: Emergency E-Mail: Section B: Accompanying Persons Please check the box and fill in the Family, First and Middle name of the accompanying person(s). 1. Family Name: First Name: Middle Name: 2. Family Name: First Name: Middle Name: 3. Family Name: First Name: Middle Name: Section C: Dietary Preferences For Gala Dinner only Vegetarian: Yes / No / Other Section D: Registration Fees One Registration Form per Delegate/Exhibitor/Speaker EARLY REGISTRATION If payment received on or before 15th May 2009 REGULAR REGISTRATION If payment received on or after 16th May 2009 and before 2nd Oct 2009 ON-SITE REGISTRATION If payment received on 3rd Oct 2009 onwards Delegate R 5500 R 6000 R 7000 African Delegate R 3000 R 3500 R 4500 Midwife R 2250 R 3000 R 3500 Africa Midwife R 1500 R 1750 R 2250 Accompanying Person(s) * R 1350 No. of Persons 0 1 2 3 4 5 6 7 8 9 10 Total Accompanying Person(s) * (African Delegate) R 800* No. of Persons 0 1 2 3 4 5 6 7 8 9 10 Total TOTAL OF SECTION D * Accompanying Person(s) cannot attend any scientific sessions Section E: Reservation for Cultural Programme Events Please indicate attendance at the Opening & Closing ceremonies in order to confirm the seating. THE CULTURAL EVENTS PROGRAMME Date Cultural Programme Events Code Price per Person Total No. Attending Total Cost Sunday 4 Oct Opening Ceremony N/A Included in Registration Fee 0 1 2 3 4 5 6 7 8 9 10 INCL Monday 5 Oct A Cultural Evening a) Jazz Evening CE01 R 450 0 1 2 3 4 5 6 7 8 9 10 b) Gourmet Evening CE02 R 450 0 1 2 3 4 5 6 7 8 9 10 c) Harbour Cruise and Dinner CE03 R 450 0 1 2 3 4 5 6 7 8 9 10 d) African Experience CE04 R 450 0 1 2 3 4 5 6 7 8 9 10 e) Cocktails at the Predator Tank CE05 R 300 0 1 2 3 4 5 6 7 8 9 10 f) African Dining Experience CE06 R 400 0 1 2 3 4 5 6 7 8 9 10 Tuesday 6 Oct FIGO Evening for All OF01 Included in Registration Fee 0 1 2 3 4 5 6 7 8 9 10 INCL Thursday 8 Oct FIGO Gala Banquet OF02 R 750 0 1 2 3 4 5 6 7 8 9 10 Friday 9 Oct Closing Ceremony N/A Included in Registration Fee 0 1 2 3 4 5 6 7 8 9 10 INCL TOTAL OF SECTION E Section F: Airport Transfers Airport transfers can be arranged between Cape Town International Airport and any of the official FIGO 2009 Congress Hotels & Service Apartments. Zone One - R200.00 per person per transfer, one way. This transfer cost will cover the following areas: Bantry Bay, Camps Bay, Central City, Devil's Peak, De Waterkant, Foreshore, Gardens, Green Market Square, Green Point, Mowbray, Sea Point, Tamboerskloof, Waterfront, Woodstock. Zone Two - R225.00 per person per transfer, one way. This transfer cost will cover the following areas: Bellville, Blouberg, Cape Town Airport, Century City, Constantia, Durbanville, Glencairn, Hout Bay, Lagoon Beach, Newlands, Panorama, Parrow, Pinelands, Table View, University estate. Transfers will be booked on the hour (Eg. If your flight arrives at 11:20, your transfer from the airport will be booked for 12:00). Kindly provide us with all the information below to arrange your transfer, 30 days prior to your arrival. Zone 1 or 2 Date of Transfer Pick up Point Flight Time Flight Number Drop off Point No. of Persons Cost per Person/Transfer Select Zone 1 Zone 2 CPT** 0 1 2 3 4 5 6 7 8 9 10 Select Zone 1 Zone 2 CPT** 0 1 2 3 4 5 6 7 8 9 10 TOTAL OF SECTION F ** Cape Town International Airport Section G: Reservation for Half-Day Tours All persons may make a reservation for these tours. (For additional tours or dates please contact Turners Conferences). Half-Day Excursions Code Depart Time Date 2 - 11 October Cost per Person No. of Persons Total Cost City & Blouberg Beach Tour CPM002 13.45 Select 02 Oct 2009 03 Oct 2009 04 Oct 2009 05 Oct 2009 06 Oct 2009 07 Oct 2009 08 Oct 2009 09 Oct 2009 10 Oct 2009 11 Oct 2009 R 330 0 1 2 3 4 5 6 7 8 9 10 Township Tour TAM003 08:15 Select 02 Oct 2009 03 Oct 2009 04 Oct 2009 05 Oct 2009 06 Oct 2009 07 Oct 2009 08 Oct 2009 09 Oct 2009 10 Oct 2009 11 Oct 2009 R 350 0 1 2 3 4 5 6 7 8 9 10 TAM004 13:45 Select 02 Oct 2009 03 Oct 2009 04 Oct 2009 05 Oct 2009 06 Oct 2009 07 Oct 2009 08 Oct 2009 09 Oct 2009 10 Oct 2009 11 Oct 2009 R 350 0 1 2 3 4 5 6 7 8 9 10 Winelands Tour WAM005 08:15 Select 02 Oct 2009 03 Oct 2009 04 Oct 2009 05 Oct 2009 06 Oct 2009 07 Oct 2009 08 Oct 2009 09 Oct 2009 10 Oct 2009 11 Oct 2009 R 450 0 1 2 3 4 5 6 7 8 9 10 WPM006 13:45 Select 02 Oct 2009 03 Oct 2009 04 Oct 2009 05 Oct 2009 06 Oct 2009
THE CULTURAL EVENTS PROGRAMME
Zone One - R200.00 per person per transfer, one way. This transfer cost will cover the following areas: Bantry Bay, Camps Bay, Central City, Devil's Peak, De Waterkant, Foreshore, Gardens, Green Market Square, Green Point, Mowbray, Sea Point, Tamboerskloof, Waterfront, Woodstock. Zone Two - R225.00 per person per transfer, one way. This transfer cost will cover the following areas: Bellville, Blouberg, Cape Town Airport, Century City, Constantia, Durbanville, Glencairn, Hout Bay, Lagoon Beach, Newlands, Panorama, Parrow, Pinelands, Table View, University estate.
Transfers will be booked on the hour (Eg. If your flight arrives at 11:20, your transfer from the airport will be booked for 12:00). Kindly provide us with all the information below to arrange your transfer, 30 days prior to your arrival.
