GDOP 2010

Personal details

Items marked with an asterisk (*) are required.

First Name: *

Surname: *

Gender: *

Title: *

If other, please enter

Preferred Name on Badge:

(Nickname to replace FIRST NAME only)

Date of Birth: *

(YYYY-MM-DD)

Spoken Language: *

How/where did you hear about
the GDOP 2010 Conference?

Address

Postal Address:

City:

Zip/Postal Code:

Country: *

Contact Details

Country Telephone Code: *

Tel:

Fax:

Mobile:

Email: *

Re-Enter Email: *

Organisation

Organisation / Institution:

Designation / Position:

Network Affiliation

Primary Network Affiliation:

Additional Network Affiliation 1:

Additional Network Affiliation 2:

If other, please specify

RSA Citizens:

ID No:

Non-RSA Citizens:

Passport Country of Issue:

Passport No:

Passport Expires:

(YYYY-MM-DD)

Registration Fee

International

Conference Registration	US$250.00
Day Registration - Wednesday	US$85.00
Day Registration - Thursday	US$85.00
Day Registration - Friday	US$85.00

South African Citizens

Conference Registration	R1750.00
Day Registration - Wednesday	R600.00
Day Registration - Thursday	R600.00
Day Registration - Friday	R600.00

Please click here to see the conference program for details regarding Day registration.

Travel

Please note that a complimentary airport shuttle will be available on your arrival and departure.

Please select this option
if you will NOT be needing the
complimentary airport shuttle service

Arrival at Cape Town International Airport

Date:

(YYYY-MM-DD)

Time:

(24hr format, e.g. 16:15)

Flight:

Departure from Cape Town International Airport

Date:

(YYYY-MM-DD)

Time:

(24hr format, e.g. 16:15)

Flight:

Accommodation

Accommodation:

If other, please specify:

Accommodation Booked?

Yes No

Accommodation Check-In Date:

(YYYY-MM-DD)

Accommodation Check-Out Date:

(YYYY-MM-DD)