SAPICS Regional Conference Registration form 2017 All prices on this form are exclusive of VAT. Title*Prof.Dr.Mr.Mrs.Ms. Name First Last Job Designation*Mobile Phone*Email* Company Name*Company Phone*Postal Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country VAT NumberPlease indicate which certification you hold from APICS SCC/ DDI / IBF certification (if applicable)Please selectCPIMCFPIMCIRMCSCPCLTDCPFACPFCDDPSCOR-PCSCAMembershipPlease selectYesNoAre you a SAPICS Member of member of one of our Associate Partners?Is this your first SAPICS Regional Conference?Please selectYesNoMember FeeMember of SAPICS or Associate Partner R2,950 Excl. VATNon member FeeNon Members R3,500 Excl. VATAPICS, IBF, Fapics, SAIIEPlease indicate which regional conference will you be attending?*Please SelectGauteng Regional, 5 September 2017, The Maslow, SandtonKwazulu-Natal Regional, 6 September 2017, The Durban Hilton, DurbanWestern Cape Regional, 8 September 2017, NH Lord Charles Hotel, Somerset WestThe following group discounts are available only if groups are booked by one central administrator and paid for at the same time 5-9 Delegates - 5% off published registration fee at the time of payment 10-29 Delegates - 10% off published registration fee at the time of payment 30+ Delegates - 15% off published registration fee at the time of payment Special Dietary RequirementsNoneHalaal FriendlyHalaal StrictKosherVegetarianPayment Options*Internet Transfer (EFT)Credit CardDirect DepositThis is for information purposes only. If you opted for the Credit Card payment a representative will contact you shortly for the credit card details. A tax invoice will be issued immediately upon receipt of the completed registration form. Registration will be confirmed after payment is received. Fees will apply.Future Correspondence*YesNoWe will not sell, distribute or lease your personal information to third parties. If you wish to receive future correspondence from SAPICS in respect of newsletters, events, education and the like, kindly mark the relevant box. Terms and Conditions*YesNoI have read, understood and accept the Terms and Conditions.NameThis field is for validation purposes and should be left unchanged.