Overview on Botox and FES Workshop
JURIE WESSELS SEMINAR ROOM, PASTEUR HOSPITAL
24 November 2006
Name: ________________________ Surname: _____________________________
Title: _________________________ Position: _____________________________
Phone No.: ____________________ Fax No.: ______________________________
Company Name: __________________________________________________________
____________________________ Postal Code ___________________________
Registration Deadline: 17 November 2006
Would you like the course to be presented in Afrikaans/English (underline your
Special meal requirements:
Kosher Vegetarian Halaal Normal
Participants are encouraged to register early as place is limited. Please confirm your
place telephonically with Corina Botha at 051 – 5201234 there are limited places.
Please complete the attached registration form and fax with proof of payment to
Corina Botha on (051) 5201231 (e-mail: email@example.com) Payment
can only be made by direct deposit into the SASCA account. Registration will only be
confirmed once proof of payment is received.
Please write your name as a reference on the deposit slip.
Bank: Standard Bank
Acc Name: SASCA
Branch Code: 01-26-45-40
Acc Number: 012 257 036