Registration

 

All fields marked with (*) are required.

Title*
Please specify your title
First Name*
Please fill in your First Name
Surname*
Please fill in your Last Name
HPCSA No
Please HPCSA number
Country*
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Cell No
Please fill in your cell number
Telephone No
Please fill in your cell number
Profession*
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Email Address*
Please fill in your email
Special meal requirements:*



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Registration Fees

Pre-Congress Workshops Thursday 21 Nov 2019

Please Choose Only One Option






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Full Congress Fri 22 - Sun 24 Nov 2019

Early Registration Fee: By 31 Aug 2019 (Fees will increase hereafter)
Specialists
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Registrars, Medical Officers & other Allied Professionals
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Day Registration Fri 22 Nov 2019

Specialists
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Registrars, Medical Officers & other Allied Professionals
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Day Registration Sun 24 Nov 2019

Specialists
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Registrars, Medical Officers & other Allied Professionals
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Social Events

Welcome Cocktail Function, Thursday 21 Nov 2019

Included in registration fees for congress delegates attending the full congress

Delegate*
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Partner and Spouses*
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Congress Dinner, Sat 23 Nov 2019

Not Included in registration fees
Delegate
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Partners and Spouses
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Payment Instructions

Workshops Total
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Full Congress Total
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Day Registration Total
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Partner Spouse Total
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Social Function Total
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Full Total
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Choose Payment Type*
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- Please use your surname as a reference number when submitting payment
- Please note that all bank charges are to be borne by the delegate.

BANK DETAILS
Name of Account: ICOA 2019
Bank: ABSA - Clearwater
Account No: 9344401040
Branch code: 632005
Account Type: Savings account
Swift Code: ABSAZAJJ

Thank you for choosing the Credit Card payment method

Once you have completed the registration and clicked on the submit button, the amount that you have chosen will be displayed as well as a field where you can enter the amount that you would like to pay.

Complete the field with your chosen amount and then click on the "Pay Now" button. Once you have clicked on the button you will be redirected to Payfast for secure online credit card transactions.

Cancellation of Registration:
Notice of cancellation must be given in writing. Any cancellations received before 31 September 2019 will be charged a penalty fee of 50% Any cancellations received after this date will result in a 100% cancellation fee.

Anti-Spam:*
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If you have filled in all the required fields, you can submit your registration and continue to the payment page.
   
Total Paid
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Unpaid
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Date of Payment
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OR
SPECIAL OFFER! REGISTER FOR BOTH - CHOOSE: EITHER