Register

Kindly complete this form.

The organisers will issue an invoice upon receipt of your Registration Form. Banking details will be on the invoice. When effecting payment, please use your name and surname or account number (which appears on the invoice) as the reference.

Surname *

Initials *

Title *

Name * The name to be printed on your name tag e.g. Thys Burger.

HPCSA Number

Email Address *

Cellphone Number *

Institution/Organisation *

City/Town *

Address * Full address for invoice.

Postal Code *

Country *

Do you want to attend the Navigating the Depths: Anaesthesia Unveiled with Targeted Precision Workshop in person on Friday 16 February @ 18:00? (No virtual option) *

Yes

Do you want to attend the Innovation symposium/workshop on Saturday 17 February 2024 in person? *

Yes

Do you want to attend the Innovation symposium/workshop on Saturday 17 February 2024 virtually? *

Yes

Will you attend the Fresenius Kabi Welcome function, Friday, 16 February? *

Yes

Will you attend the Informal Fun Function, Saturday, 17 February? *

Yes

Do you have any special dietary requirements?

Full Registration

Registrar

Total Due

By submitting this Registration Form you are accepting liability for the payment of the outstanding fees. Should the fees be payable by your company of institution you will be responsible for ensuring that these are paid prior to the congress.