2012 ACFE Annual Conference Registration Form

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2012 ACFE Annual Conference Registration Form Powered By Docstoc
					                                                       Registration form:
            ACFE        5th   Annual African Conference and 14th SA AGM                              1-3 October 2012
                  FAX TO 086 549 1577 OR 012 346 1927 OR E-MAIL TO memberservices@acfesa.co.za

                                                  BILLING INFORMATION

Company/ Organization                                                           Company VAT no

Postal Address                                                                  Department/ Cost Centre

                                                                               E-mail Billing Address:
 The ACFE Registration Officer will issue an invoice for payment with bank details and a deposit reference, after the registration application
  has been processed. If you don’t get confirmation of your booking contact us on 012 346 1913. Please do take notice of the Terms and
                                               Conditions as outlined in the Course Brochure

                                                        AUTHORISATION
First (Preferred) Name:                                                         Surname:
Position: (Job title)                                                           Company/ Organisation:
Signature                                                                       Date:
Signatory must be authorized to sign on behalf of Company
     DELEGATE 1 PLEASE PROVIDE INFO AS IT SHOULD APPEAR ON YOUR NAME BADGE

First (Preferred) Name:                                                         Surname:
Position: (Job title)                                                           Company/ Organisation:
E-mail Address:                                                                 Designation:  CFE         Associate  Affiliate

SPECIAL REQUIREMENTS eg. Disabilities (please state what arrangements are required)
SPECIAL MEALS: I require a specially ordered meal and will pay the surcharge: □ Halaal □ Kosher
My contact details ( e-mail address) may be published on the delegates list for networking purposes □ Yes        □ No
DELEGATE SIGNATURE: ________________________                 DATE: __________________ PLACE: _________________

     DELEGATE 2 PLEASE PROVIDE INFO AS IT SHOULD APPEAR ON YOUR NAME BADGE
First (Preferred) Name:                                                         Surname:
Position: (Job title)                                                           Company/ Organisation:
E-mail Address:                                                                 Designation:  CFE         Associate  Affiliate

SPECIAL REQUIREMENTS eg. Disabilities (please state what arrangements are required)
SPECIAL MEALS: I require a specially ordered meal and will pay the surcharge: □ Halaal □ Kosher
My contact details ( e-mail address) may be published on the delegates list for networking purposes □ Yes        □ No
DELEGATE SIGNATURE: ________________________                 DATE: __________________ PLACE: _________________

     DELEGATE 3 PLEASE PROVIDE INFO AS IT SHOULD APPEAR ON YOUR NAME BADGE
First (Preferred) Name:                                                         Surname:
Position: (Job title)                                                           Company/ Organisation:
E-mail Address:                                                                 Designation:  CFE         Associate  Affiliate

SPECIAL REQUIREMENTS eg. Disabilities (please state what arrangements are required)
SPECIAL MEALS: I require a specially ordered meal and will pay the surcharge: □ Halaal □ Kosher
My contact details ( e-mail address) may be published on the delegates list for networking purposes □ Yes        □ No
DELEGATE SIGNATURE: ________________________                 DATE: __________________ PLACE: _________________

				
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