REGISTRATION FORM




TOPICS IN BIOSTATISTICS
10 - 21 JUNE 2013, SACEMA, UNIVERSITY OF STELLENBOSCH



SURNAME:
FIRST NAME:
NATIONALITY:
EMAIL ADDRESS:
CONTACT Tel. No:
ID/PASSPORT NO:
AGE:
GENDER:
CURRENT STUDIES (if relevant):
CURRENT EMPLOYMENT (if relevant):
STUDY/RESEARCH AREA:
INSTITUTION/EMPLOYER:
Contact number:
email:

_______________________________________________________________________________
BACKGROUND

Specify what courses in statistics you have already taken:
Payment details will be sent to you on receipt of this Registration Form. The closing date for early bird registration is 22 March 2013, by which date a non-returnable registration fee of R1000 / 100 euros must be paid. The total early bird course fee is R8500 (or 800 euros for international participants).

The closing date for later registration is 22 April 2013, by which date a non-returnable registration fee of R1000 / 100 euros must be paid. The total course fee for later registrations is R8500 (or 900 euros for international participants).

If you have difficulties with the online application process, contact:
Lynnemore Scheepers , to whom all enquiries should be made.
Phone: +27 21 808 2589, fax: +27 21 808 2586.