OASA Congress 2009 - Registration Form

OASA Congress 2009 Registration Form

All fields marked with * are required.
Register and Pay before 01 October 2009
NO registration at the door.

Full Name: *

Email Address: *

Telephone: *

Select the appropriate category to expand this form

OASA Member

Ocularist - Not a member of OASA

Guests example: GP's, Orthoptists, Ophthalmic Nurses & Sisters

View Pricing for all Categories

Indicate your Discipline:

Ocularist	General Practitioner	Ophthalmic Nurse
Orthoptist	Ophthalmic Assistant	Ophthalmic Sister
Other	If Other, please specify:

Congress Fee for OASA Members
Two days: R2,995.00 - Early bird discount R2,550.00
One day: R2,565.00 - Early bird discount R2,095.00

Congress Fee for Ocularists - Not a member of OASA
Two days: R3,895.00 - Early bird discount R3,315.00
One day: R3,345.00 - Early bird discount R2,725.00

Congress Fee for Guests attending the Saturday only
One day: R550.00 - Early bird discount R495.00

(Sunday is Beneficial to Ocularists only)

Saturday Dinner

Round the world dinner R175.00 per person

How many persons:

River Rafting - getting to know the Ocularists in your area

River paddle OASA members R250.00 per person

How many persons?

River paddle
Guests / non-OASA members R270.00 per person

How many persons?

River paddle
Guests / non-OASA members R270.00 per person

How many persons?

Accommodation at Amanzingwe

Standard Room & Breakfast Single or Sharing - R1100.00 per Night

Check-in:	Check-out:	No of Rooms:	Nights:

Family Room & Breakfast - R1180.00 per Night
(2 X adults + 2 X Children under 16**)
**Children over 16 pay R250 per head
Children under 16 pay al meals and extras

Check-in:	Check-out:	No of Rooms:	Nights:	Kids > 16:	Kids < 16

Please book direct with Amanzingwe bush Lodge
Telephone 012-205-1108
Facsimile 012-205-1248
E-mail: annette@amanzingwe.co.za
Website: www.amanzingwe.co.za

Additional Comments:

Payment

Please deposit: using your name as reference:

Bank: FNB - Cresta
Account Name: OASA
Account No: 62029987908
Account Type: Current account
Branch Code: 254905

Fax proof of payment to:
011 704 3775 or
email: eyesalive@worldonline.co.za

Payment MUST be received to finalize registration.

Cancellation / Refund Policy:

All cancellations and request for refunds must be in writing.
Non arrival or cancellation after 25 September 2009 will result in 100% penalty of the agreed package amount.

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