Registration form for ISAIT 2005
Please fill-in the following registration form:

	Title	First Name	Surname	Designation	
1	     	     	     	     	
2	     	     	     	     	
3	     	     	     	     	
4	     	     	     	     	

Company	     	
VAT Registration No	     	
Postal Address	     	
Postal Code	     	
Telephone	     	Cellular	     	
Fax	     	E-Mail	     	

Special Dietary Requirements:	
	Vegetarian		Non- vegetarian		Halaal		Kosher	

Registration options

You have following easy options of registration:
Phone	:	+27 11 233 5418 
Please call and request for registration.	
Fax	:	+27 11 233 5361	
Post	:	Tsar Events, Division of Travcare, 
P. O. Box 76648, Wendywood 2144, 
Johannesburg, South Africa	
Email	:	isait2005@travcare.co.za / jean@travcare.co.za	

Note: All the bookings will only be confirmed once we receive full payments; your provisional booking on receipt of your details can be held only for two weeks. 

Payments:
You may choose one of the following payment methods: 
A)	Bank transfer / Electronic funds transfer
B)	By Credit Card
C)	By Cheque – applicable to South African delegates only

A) PAYMENT BY TELEGRAPHIC TRANSFER OF FUNDS

Payment by bank telegraphic transfer can be made directly into the Travcare bank account as follows: -

Bank Name  			Standard Bank of South Africa
Bank Account Name		Travcare
Bank Account Number	022985123
Branch Name			Rivonia
Branch Code			001255
Swift Code			SBZAZAJJ

Please supply name, address, name of company/organization and fax number on the transfer reference and fax back a copy on +27 – 11- 233 5361.

B) PAYMENT BY CREDIT CARD

The cardholder must fill in this form and sign it to authorize Travcare or service provider selected by Travcare to debit the credit card.

NB – For security reasons, a photocopy of the front and back of the credit card and the cardholder’s passport must please be faxed together with this authorization form to Travcare on +27-11-233 5361.

I,       (cardholder full name) hereby authorize Travcare or its service provider to charge my       (Credit card type) 
Credit Card Number      
Expiry date       CVC number       (last 3 digits on back of card) with the amount of USD/ZAR       (Budget/Straight payment as if I had been present with my card.

Address	     	
Mother’s maiden
(if necessary)	     	
Name on card	     	
Name of Bank	     	
Card color	     	
Date of Birth	     	
ID/Passport no.	     	
Country of issue	     	

Cardholder’s signature		
Date signed      	
Place signed