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									                11th Annual UNESCO/IUPAC Workshop & Conference on
                          Functional Materials & Composites
                        Stellenbosch, South Africa: 26 – 29 April 2011

                                                 REGISTRATION FORM
       Please complete a separate form for each participating delegate.
       Registration fee includes: Conference Proceedings Book, coffee and lunch, welcome reception
       Reservations for ACCOMMODATION must be made directly at guest houses.
        Please visit conference website: http://www,sun.ac.za/unesco
 Please type or write clearly in block letters

First Name                                                 Last Name

Title                                                      Nationality

Occupation                                                 Passport No


Mailing address

Zip                                              Country                           Cell
Code                                                                               Mobile

Tel                                              Fax                               E-mail

Dietary Requirements(i.e. vegetarian, halaal, please specify)

Accompanying Persons Name                                                    Passport No

Accompanying Persons Name                                                    Passport No

 Are you also submitting abstract(s)?

 □      Yes. Please also fill in “Call for Papers Submission Form” /                     □    No.

 (I) Registration: Conference & Workshop: 26-29 November 2011

                         Description                            Before 30 Nov 2010            After 30 Nov 2010

 Full participants / Invited Speakers (banquet                            R2800                       R3000

 Students / US Personnel (banquet excluded)                               R1500                       R1500

 Scientists from Developing Countries                                     R1500                       R1500

 Workshop (1 day) Participants / Students                                 R500                        R500

 Conference Banquet (transport included)                                  R350                        R350

                                                                         TOTAL I

 Thursday, 03 February 2011                                                                                       1
(II) Welcoming Session and Conference Banquet
                              Description                                   Number of Persons     Total Amount

WELCOMING SESSION: Tuesday, 26 April 2011, Time: 16:00 –                                             Not
18:00, Refreshments will be served (FREE OF CHARGE)                                               applicable

*CONFERENCE BANQUET, VENUE WILL BE CONFIRMED                                     R350                R350
Date: Thursday, 28 April 2011, Time: 19:00

*For full participants: included in registration fee; for accompanying persons: R350 per person

                                                                            TOTAL II

Flight / Accommodation Details

                 ARRIVAL IN CAPE TOWN                               DEPARTURE FROM CAPE TOWN

 Date      Flight No         Time              Name of              Date         Flight No           Time

Cancellation Policy

A 50% refund is applicable to cancellations made before 31 January 2011. The
Organizing Committee regrets that no refund on cancellation is possible after this date.

 Method of Payment                                 GRAND TOTAL (I + II)

Please complete attached credit card authorization form.

□ I will pay by credit card □ Master or □ Visa.
□ I have remitted the above grand total from my bank_____________________on
    Date________________ payable in USD or RAND (copy enclosed) to:

    Account Name: The Macromolecular Society of SA
    Address of Bank: ABSA Bank, Plein Street, Stellenbosch
    Account number: 41 019 0621
    Bank / Sorting Code: 334410 45
    Swift Code: ABSAZAJJ


This form should be returned (either by fax or e-mail) to the Conference Secretary,
Aneli Fourie, Fax: +27(21) 808-4967, E-mail: aef2@sun.ac.za

Thursday, 03 February 2011                                                                                  2
I hereby authorize that my Credit Card Account be debited in favour of The
Macromolecular Society of SA with the amount as indicated hereunder in respect of my
enrolment and registration fee for the 11th Annual UNESCO/IUPAC Workshop &
Conference on Functional Polymeric Materials & Composites that will be held in
Stellenbosch, South Africa from 26 - 29 April 2011.

Name of card holder (Please print clearly):___________________________________
Number of Passport:____________________________________________________

Credit card number:

Expiry date:

CVC number (last three digits of number on reverse side of the card):

Name of card (VISA or MASTER):_______________________________

Amount to be debited against card account:
Currency (£ Sterling / Euro / US $ / Rand ): _____________Total:______________
(Office use only: Forex rate:___________; Project cost number:________________)

Signature of card holder:_________________________Date:_______/_____/_____

NB! If you are paying on behalf of a third party, please give the name and
contact details of that person:

          Mail or fax this form together with your registration form to the
                               Conference Secretary:
      Attn: Mrs Aneli Fourie; Tel: +27(21) 808-3174, Fax: +27(21) 808-4967
                             E-mail: aef2@sun.ac.za

Thursday, 03 February 2011                                                        3

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