Please register by completing the accompanying registration form.
FOUNDATION PROVISIONING/EXTENDED PROGRAMMES REGIONAL WORKSHOP
REGISTRATION FORM
23RD & 24TH APRIL 2015
Please complete and return:
E-mail: fprw@ufh.ac.za
TITLE
FIRST NAME
INITIALS
SURNAME
ORGANISATION
POSITION
ADDRESS
POSTAL CODE
TEL NO
FAX NO
EMAIL
Catering: Tick appropriate box
NORMAL
VEGETARIAN
HALAAL
VEGAN
BANK DETAILS FOR PAYMENT OF REGISTRATION FEE:
BANK : FIRST NATIONAL BANK
BRANCH : VINCENT PARK EAST LONDON
BRANCH CODE : 211-021
ACCOUNT NAME: UNIVERSITY OF FORT HARE
ACCOUNT NO: 62008303357
BANK SWIFT: FIRNZAJJ846
BIC : 21-10-21
Reference: PROJ689-PLUS SURNAME
Date:
Surname: