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.: English Registration Form

This form is divided into six sections:

  • Section One, must be completed in full by all attendees;
  • Section Two, for those attending the General Assembly;
  • Section Three, for those attending the Women's Forum;
  • Section Four, for those interested in the events listed;
  • Section Five, More information only for those who require accommodation in Cape Town, (except those who have applied for subsidy to support their attendance);
  • Section Six, for those who are paying registration fees and/or reserving accommodation.

A separate registration form should be completed for each person attending.

SECTION ONE PERSONAL INFORMATION
 SECTION ONE: PERSONAL INFORMATION
Family Name: [ mandatory ]
Given Name: [ mandatory ]
Gender:[ mandatory ]
Male: Female:
Title:
Mr    Mrs    Miss    Dr    Prof    Rev   
Organisation Name: [ mandatory ]
Postal Address: [ mandatory ]
Country: [ mandatory ]
Region: [ mandatory ] Africa   Europe   North-America/Carribean
East Asia / Pacific   Asia   Latin America
Telephone: [ mandatory ]
Fax:
Email: [ mandatory ]
Please indicate:
[ mandatory ]		 Blind  Vision Impaired
Sighted  Deaf Blind
Preferred Language:
[ mandatory ]		 English  French  Spanish
Preferred document format: [ mandatory ]
Braille:
English Contracted
English Uncontracted
French Uncontracted
Spanish Uncontracted
Casette:
Large Print:
Disk Ascii / text file:
Disk MS-Word:
Adobe PDF:
Normal Type Print
Full Name on Passport: [ mandatory ]
Passport Number: [ mandatory ]
Expiry Date: [ mandatory ]
Place of Issue: [ mandatory ]
Date of Birth: mm/dd/yy [ mandatory ]
Have you applied to the Secretary General's Office for travel subsidy to support your attendance at the General Assembly and/or Women's Forum?  [ mandatory ]     Yes    No
 
SECTION TWO SIXTH GENERAL ASSEMBLY REGISTRATION
 SECTION TWO: SIXTH GENERAL ASSEMBLY REGISTRATION
You wish to register for the General Assembly as a: [ mandatory ]
Delegate:
Observer:
Table Officer:
Guide / Interpreter:
 
DELEGATES are you representing a:
National Member:
Group Member:
Special Member:
An International Member:
Associate Member:
OR
 
Are you an Honorary Life Member:
   
DELEGATES/OBSERVERS,if you will be accompanied by a Guide/Interpreter, please indicate that person's name and complete a separate Registration Form for him/her.
Guide/Interpreter's Name:
   
GUIDES/INTERPRETERS, please indicate the name of the Delegate/Observer who you will be travelling with and assisting at the Assembly
Name:
   
SECTION THREE THIRD WORLD BLIND UNION WOMEN'S FORUM
 SECTION THREE: THIRD WORLD BLIND UNION WOMEN'S FORUM
You wish to Register for the Women's Forum as a:
Delegate:
Observer:
Guide / Interpreter
Accompanying Person:
 
DELEGATES/OBSERVERS,if you will be accompanied by a Guide/Interpreter, please indicate that person's name and complete a separate Registration Form for him/her.
Guide/Interpreter's Name:
   
GUIDES/INTERPRETERS, please indicate the name of the Delegate/Observer who you will be travelling with and assisting at the Assembly
Name:
   
ACCOMPANYING PERSON: Please indicate the name of the Delegate/Observer you will be accompanying.
Name:
   
SECTION FOUR: ASSOCIATED EVENTS
 SECTION FOUR: ASSOCIATED EVENTS
Will you attend the WBU Executive meeting on Sunday 5 December 2004 ? [ mandatory ]
Yes    No
 
Do you plan to attend the WBU Executive Meeting on Saturday 11 December 2004 ? [ mandatory ]
Yes    No
 
SECTION FIVE: ACCOMMODATION INFORMATION ONLY
 SECTION FIVE: ACCOMMODATION INFORMATION ONLY

Delegates who have applied for subsidy to meet their accommodation costs will be contacted once subsidy applications have been considered.

Date of Arrival: / / 2004

Date of Departure: / / 2004

Please indicate accommodation type required:
 
    Single, one person per room
Twin, two people, two beds
Double, two people, one bed

Name of person you wish to share with:
     

The conference hotels are listed below. Please indicate a first and second preference. Also indicate non-smoking if required.

Holiday Inn (4 star) across the road from the meeting venue

first choice second choice


R 710, 00 for person sharing twin or double ( non smoking )

R 1060, 00 single room

Cullinan (4 star) across the road from meeting venue

first choice second choice

R710, 00 per person sharing twin or double ( non smoking )

R 1060, 00 per single room

 

Arabella Sheraton Grand Hotel (5star) on site of the meeting venue

first choice second choice

R660, 00 person sharing twin or double ( non smoking )

R 970, 00 single room

 

The Capetonian Hotel has been reserved for WBU supported delegates.

Rates quoted above are per person, per night inclusive of breakfast, government levy and VAT.

ALL BOOKINGS MUST BE MADE THROUGH OUR OFFICE TO ENJOY THE SPECIAL RATES

Accommodation must be paid in South African Rand

A minimum deposit of two night’s accommodation is required upon booking and the balance MUST be paid by 1 October 2004 .

PLEASE BOOK EARLY

SECTION SIX: FINANCIAL DETAILS
 SECTION SIX: FINANCIAL DETAILS
Registration Fees and Accommodation Deposits must be paid at time of registration
(unless your attendance will be subsidised through the Office of the Secretary General)
We strongly recommend that you arrange for an Electronic Funds Transfer from your bank
to our account.

Our banking details:

WBU 6th General Assembly
Bank Name: Standard Bank, Wynberg
Account Number: 071743626
Branch Code: 025309
Swift Number: SBZAZAJJ

Please ensure that a copy of the Bank transfer is faxed to: +2721 705 3754
Please make the appropriate selection for your Registration below:

Registration for General Assembly: [ mandatory ]

Delegate US $250.00
Observer US $150.00
Interpreter/Guide US $150.00
S.A. Observers US $ 15.00

Registration for Women's Forum:

Delegate US $100.00
Observer US $100.00
Interpreter/Guide US $ 80.00
Accompanying Person US $ 80.00
S.A. Observers US $ 15.00


REGISTRATION TOTAL: US $

ACCOMMODATION TOTAL: ZAR

Thank you for completing this form. Once you click submit a copy of this form will be e-mailed to the General Assembly.

Please note that your payment must be received by the latest 31 June 2004.

Please note that a late registration fee of $12.00 is payable if not registered for attendance by 30 June 2004.
No more registrations will be accepted after 01 October 2004.

Please e-mail your final travel arrangements, once confirmed i.e. time of arrival and departure to the organising committee in order for us to arrange your transport. E-mail info@wbucapetown2004.org.za

© world blind union 2004