Bank :Standard Bank

Account Name :ETK Electronic

Account number :050134116

Account held :Kingsmead

Branch code :040 026

Reference :200 9360 7207

Contact details:

Hlengiwe Mthethwa Tel: 031 311 4578, mthethwah@durban.gov.za

Nondumiso Mhlongo Tel: 031 261 5585, mhlongonondumiso@durban.gov.za

WOMEN EMPOWERMENT CONFERENCE

REGISTRATION FORM DELEGATE INFORMATION

Title :

First name:

Surname:

Preferred name on name tag

(if different to above):

Institution/organisation:

Industry sector:

CONTACT INFORMATION

Postal address:

Telephone number:

Facsimile number:

Mobile number:

Email address:

DIETARY INFORMATION

REGISTRATION FEES

The conference costs R100 per person and includes access to all sessions:

16 August 2012 – Conference (8h00) &

Gala dinner at International Convention Centre (ICC) - 18h00

17 August 2012 – Conference/Excursion (8h00 – 16h00)

Please note the conference is only open to women owned business over one year old.

PAYMENT DETAILS

Payment can be made by direct deposit or EFT only.

Please make sure you reference is your initial and surname.

We regret we will not accept cheques or credit card payments.

Please drop all the registration forms at 75 Dr Langalibalele Street (Winder Street), 11th floor or fax: 086 721 7108

RSVP deadlines: 3 August 2012