OSSA 2017 Congress

Online Registration

Please ensure that you receive a confirmation by e-mail from the organisers within 10 working days.

E-MAIL / FAX proof of payment to ossacongress@telkomsa.net / + 27 (0) 86 60 60 555 BEFORE 16 November 2016.

Important request to companies sponsoring delegates:
Kindly let us have the delegate’s personal postal address and other contact information.

Personal Details
Title
 
Initials
 
First Name
 
Surname
 
Preferred Badge Name
 
Occupation
Specify
HPCSA Number
Company / Institution
VAT Number
Postal Address
 
City
 
Province
 
Country
Postal Code
 
Business Telephone
 
Business Fax
Mobile Number
 
Email Address
Special Dietary Requirements
Specify
Accommodation

You are responsible for your own accommodation arrangements.

Where do you plan to stay?
 
Specify
Travel Arrangements

I have made arrangements to travel by air and wish to make use of the shuttle service between Port Elizabeth Airport and the Boardwalk Hotel.

Use Shuttle Service
Number of People Using Shuttle
(x R300)


Shuttle from Port Elizabeth International Airport

Flight Number
Date
March
Time
(hh:mm)
Shuttle Time


Shuttle to Port Elizabeth International Airport

Flight Number
Date
March
Time
(hh:mm)
Shuttle Time
Attendance
OSSA Member?
 
Delegate Type
 
I will attend entire duration


I will only attend specific days - select days:  

Thursday
Friday
Saturday
Social Functions
Delegate
Accompanying
Guests
Welcoming Function (16 March)
(Free)
(x R400)  
OSSA Banquet (18 March)
(R400)
(x R400)  
Workshops
Genop Healthcare: 6th Heidelberg Users' Workshop
(Wednesday, 15 March,
13:00 - 17:00)
(Free)  
Genop Healthcare: Pentacam and Refractive Workshop
(Thursday, 16 March,
08:00 - 10:00)
(Free)  
Payment

I am personally responsible for full payment of congress registration fees in the event that my company / organisation does not pay them.

I agree
 
Responsible for Payment
 
Method of Payment
 
Credit Card Details

Please note: Credit card details are entered at your own risk. No other parties will be held liable for any damages suffered. Thank you.

Name of Card Holder
Type of Card
Card Number
Expiry Date
(MM/YYYY)
Last 3 Digits on Reverse of Card