Register for Conference

Registration Form

Southern & Eastern Africa Network for Analytical Chemistry CONFERENCE Gaborone Sun, Gaborone, July 15th – 18th, 2007
Please complete and return these forms either by either fax or
e-mail to: SEANAC,
Telephone +267 355-2502/2479 Fax to +267 355 2836 e-mail to seanac@seanac.org Website : www.seanac.org

Personal Details

Title:

(x)

Initials :

(x)

Surname :

(x)

Firstname (for badge) :

(x)

Address :

(x)

Country :

(x)

Institute/Organization :

(x)

Email :

(x)

Tel (Work) :

Tel (Home) :

Fax :

Cell :

Special Dietary Requirements :

Name of Accompanying Person (if applicable) :

Registration Fees (x)

SEANAC Member :	US$450-00
Non-Member :	US$450-00
Student :	US$250-00

RESIDENCE ACCOMMODATION (Please tick days required)

13th 14th 15th 16th 17th 18th 19th

Accommodation @ P90.0 per night x nights @ P90.00 per night including breakfast.

Gender : Male Female (x)

ACCOMPANYING PERSON

The accompanying person shall be entitled to attend the evening social events from 15th-18th July, 2007

P75-00

SOCIAL EVENTS (x)

Payment Summary

Description	Cost
Registration Fees
Residence Accommodation Charged @ P90.00 per night x People x Nights
Accompanying Persons Fee @ P75.00
Total (BWP)

Payment Options

Methods of Payment (x)

Choose one of the following methods of payment: (please tick appropriate box)

I enclose my cheque or money order made out to SEANAC

I shall make payment by Direct Deposit (A copy of the direct deposit to be submitted with Registration Form)

I shall make payment by Bank Transfer (A copy of the bank transfer to be submitted with Registration Form)

DIRECT DEPOSITS AND BANK TRANSFER

The banking details for the SEANAC 2007Conference are as follows:

ACCOUNT NAME	SEANAC
BANK	First National Bank of Botswana
BRANCH	Mall
ACCOUNT NUMBER	620 5247 2182
BRANCH CODE	282 867
SWIFT ADDRESS	FIRNBWGX (International bank transfers)

CHEQUE PAYMENTS

Alternatively, please make Bank Drafts cheque payable to SEANAC and post it together with your registration forms to:

SEANAC 2007

C/O The Chairperson, Dr. V. Obuseng
UNIVERSITY OF BOTSWANA
DEPARTMENT OF CHEMISTRY, BUILDING 237
P. BAG UB00704, GABORONE, BOTSWANA