Registration

ELECTROCHEMSA WORKSHOP IV
International workshop on electrochemical microscopy & spectroscopy
NELSON MANDELA METROPOLITAN UNIVERSITY,  PORT ELIZABETH, SOUTH AFRICA 20 – 22 FEBRUARY 2011

Your title:    Prof  Dr  Mr  Mrs  Ms

First Names:                               

Surname:                                   

Company/University:                  

Business Address:                     

Postal Code:                              

Tel No (Include dailing code):    

Fax No (Include dailing code):    

E-mail address:                          

Abstract Submitted:                    Yes No

Abstract Title:                             

Registration Type:

FULL REGISTRATION (SACI member) R2000 only valid with SACI membership FULL REGISTRATION (Non-SACI member) R2250 STUDENT REGISTRATION R1500 EXHIBITION STAND R2500

Exhibition stands are equipped with one table and two chairs.  Any additional requirements should be arranged with the organising committee

Sponsorship:                              Yes No

Amount in ZAR:                         

Sponsors should submit an electronic logo by email to pbaker@uwc.ac.za  for advertising on the Electrochemistry division website and on all workshop printed material.

Dietry requirements:                Halaal
                                                  Vegetarian
                                                 Other

Specify dietary restrictions:     

Please Note that invoices may only be requested by email upon submission of a completed registration form to pbaker@uwc.ac.za

ABSTRACT TITLE
Authors:  Presenting author; A N Other,
Physical address , telephone number, fax number,
Corresponding author email:

BODY TEXT:
12 point Times New Roman
Maximum 1 x A4 page including figures graphics and references

Please email all abstracts to pbaker@uwc.ac.za