CHI-SA 2005 Event

Registration Form

Full-day tutorial in Cape Town:  Monday, 23 May 2005 , Breakwater Lodge, V & A Waterfront

CHI-SA Conference and tutorial in Johannesburg: 25-26 May 2005, Constantia Hotel, Midrand

Print, complete and fax this form for preferential conference and tutorial booking.
Please use a separate form for each delegate.

Title:	_________	First Name:	___________________________	Last Name:	___________________________
Company/Institution:	_____________________________________________________________________________
Postal Address:	_____________________________________________________________________________
City:	__________________________________________			Postal Code:	_________________
Tel:	_________________			Fax:	_________________
E-mail:	___________________________________________

SIGCHI/CSSA membership no.: _______________________
Dietary requirements (please mark with X):	Vegetarian	Kosher	Halaal	Other

Conference and Tutorial Fees

I would like to attend the following:

Cancellation Policy

Cancellations will be accepted until 10 working days before the conference, after which a 20% administrative fee will be charged.

Option		Fee
	Aaron Marcus Tutorial - Cape Town    Topic: Mobile Computing (23 May 2005, Cape Town)	R1750.00
	Aaron Marcus Tutorial - Johannesburg Topic: Cross Cultural User Interface Design (25 May 2005, Midrand)	R1750.00
	CHI-SA 2005 Conference Day only (26 May 2005)	R1250.00
	Tutorial in Johannesburg and Conference Day (25, 26 May 2005)	R2500.00
	Total amount payable	R

NOTE: A 50% discount on the tutorials as well as the conference is offered to students. Proof of registration as full-time student must be provided.

CHI-SA 2005 Banking Details
Account name:	CHI-SA
Account number:	1970747722
Bank:	Nedbank (Sandton branch)

Please fax this form, plus proof of your payment,
to CHI-SA 2005, for attention Gabi Erasmus
at fax number 011-315 2276.