CLASS OF 1963 REUNION
6-8 DECEMBER 2013
REGISTRATION FORM
Please complete this form and return it with your payment, by not later than 15 OCTOBER 2013.
Your details
Name:
Address:
Email
Telephone/mobile numbers:
Your payment South African Rands please
Tick your preferred payment method
cheque (payable to “UCT”)
1.
2.
3.
irect (EFT) deposits
Bank:
Account name:
Branch Code:
Account Number:
Type of Account:
Reference:
Standard Bank of South Africa, Rondebosch
UCT Sundries Account
025009
071 503 854
Current
1963surname120098 eg 1963adams120098
nternet banking
swift code
Same as direct deposits
SBZAZAJJ (foreign payments) – please include bank charges with your payment
For payment methods 2 or 3, forward a copy of your deposit slip by fax or email to Joan Tuff
Fax +27 (0)21 650 5010 or Email: joan.tuff@uct.ac.za
4.
credit card
Authority for payment by CREDIT CARD to the University of Cape Town
Please debit my
American Express
MasterCard
Visa
Amount:
Card number
Last three digits on back:
Expiry date:
dd
mm
yy
Today’s date:
Signature (essential): ……………………………
Other: specify
Class of 1963 Reunion
2
2. Programme of events
Fri, 6 Dec
07h45-08h30
08h30-08h40
08h40-10h30
10h30-10h45
10h45-12h00
12h00
Afternoon
16h30 for 17h00
Sat, 7 Dec
18h30
18h45
08h00-08h30
08h30-10h30
10h30-10h45
10h45-12h45
12h45
Afternoon
18h30 for 19h00
Sun, 8 Dec
3. Name Tags
Registration and Refreshments – Frances Ames Room, Barnard Fuller Building, Medical
School
Welcome
Introductions and Group Discussion
Tea break
Listening to CD of 1963 final year dinner (abridged version)
Lunch – MAC Club, Barnard Fuller Building
At leisure
Regraduation Ceremony – Wolfson Pavilion, Institute of Infectious Disease and Molecular
Medicine (IIDMM) Building
Class photograph
Cocktail supper, foyer IIDMM Building
Coffee on arrival
Academic Meeting, Wolfson Pavilion, IIDMM Building
Tea break
Academic Meeting (continued)
Lunch, foyer IIDMM Building
At leisure
Gala Dinner, Smuts Hall dining room, Upper Campus
A free day when colleagues can make their own arrangements
Please indicate the name/s you wish to appear on the nametag/s: (USE BLOCK LETTERS PLEASE).
SELF (First name and surname)
SPOUSE/PARTNER
4. FEES PAYABLE
FUNCTION
COST
CLASS MEMBERS
All-inclusive fee for reunion weekend
R1400.00
ACCOMPANYING PERSONS (spouse/partner/guests)
Friday Evening Regraduation Ceremony & Cocktail Supper)
@ R170 per person x
(number attending)
Saturday Morning Academic Meeting & Lunch
@ R150 per person x
(number attending)
Saturday Evening Gala Dinner
@ R300 per person x
(number attending)
TOTAL =
R
NB: YOUR PAYMENT WILL INDICATE CONFIRMATION OF YOUR BOOKING
Class of 1963 Reunion
3
5. Dietary preferences/allergies:
6. Walking disabilities:
Names of classmates who have indicated that they will be attending:
Aubry Abramson, Abe Allie, Esme Arenson, Richard Aron, Sam Bub, Cassiem D’arcy, Jose de Nobrega, Francis Diab,
Louis Diamond, Rory Dower, Peter Etellin, Sam Gerber, Michael Goldberg, Lynne Heselson, Nasheba Jardine,
Bhawan Jogei, Mike Kean, Anthony Keen, Leon Kleinman, Ralph Kolbe, Avis Kow, Douglas Kroon, Wolfgang Losken,
Hedwig Meyer, Omarjie Mohammed, Avron Moffson, Ahmed Moosa, Donald Nuss, Anton Obholzer, Paddy
Padayachey, Gerry Pillay, Cyril Press, Errol Racussen, Ashley Robins, Ernst Rösemann, Robin Rush, Stanley Sandler,
Ian Spira, John Steer, Francois van der Merwe, Jane van Jaarsveld, Ronald Walls, Eugene Weinberg, John Weinberg,
Cyril Weinkove, Emilie Wiggins, Barry Winning.
IT IS ESSENTIAL THAT YOU REPLY TO:
Joan Tuff
Alumni & Bequest Officer
UCT Faculty of Health Sciences
Private Bag X3
Observatory, 7935
Telephone +27 (0)21 406-6686
or Fax: +27 (0)21 650 5010
Email: joan.tuff@uct.ac.za
Website: www.health.uct.ac.za/alumni - this information will be available for download on the website shortly