RFA CONVENTION REGISTRATION FORM - MCLI

The Road Freight Association Die PadvragverenigingReg. No.81/10367/08 Incorporated Association not for gainRegnr.81/10367/08 Vereniging sonder winsbejagUnit E1: Isando Industrial ParkEenheid E1: Isando Industriële Parkcorner Gewel Street and Hulley Roads, Isandoh/v Gewel en Hulley Str, IsandoP O Box 511, Isando, 1600 Posbus 511, Isando, 1600Telephone (011) 974-4399 Telefoon (011) 974-4399Fax (011) 974-4903 Faks (011) 974-4903e-mail: management@rfa.co.zae-pos: management@rfa.co.zawebsite : www.rfa.co.zawebwerf: www.rfa.co.zabusiness portal: www.rfabiz.co.zabesigheids webwerf : www.rfabiz.co.zaRFA CONVENTION REGISTRATION FORMTHE GRAND PALM GABORONE, BOTSWANA19-21 JUNE 2011Company NameContact DetailsPostal Address:___________________________________________________________________Telephone: ______________________ Fax: _________________________________Cell:___________________________ Email: _________________________________Delegate Name & Surname: ___________________________________________________________________Spouse or Partner Name & Surname: ___________________________________________________________________Company VAT Number: _____________________________ Order Number: _______________________________Hotel AccommodationGrand Palm Casino & Hotel Resort has been reserved for the convention. Accommodation must be bookedDIRECTLY with The Grand Palm Hotel Gaborone.Please complete the attached booking form. Do not send to the RFA.Golfers must please note that tee-off is at 11h00 and appropriate travel and accommodation arrangements must bemade.RFA Golf Challenge19 June 2011Tee off at 11hooDelegate playing golf: Yes NoSpouse playing golf: Yes NoLadies Programme Yes NoPlease indicate any special dietary requirements (Haal, Kosher, Vegetarian and Other): ____________________________Please indicate any special needs (Wheelchair access etc.): ___________________________________Without Trucks South Africa StopsDirectors:Chief Executive:FW Wagner (Chairperson), D Joubert (Vice Chairperson), DL Behrens, GD Bolton, EL de Jager, RA Dlamini,GC Marais, PRW Meier, DI Moe, PW Mountford, DC Smit, M Sodalay, SJ Swanepoel, S Temple, GJ van der Horst,N van der Westhuizen, WJM van WettenS Naidoo (Ms)

CONVENTION FEES (ALL PRICES INCLUDE VAT) AMOUNT PLEASE TICKRFA MEMBERSDelegates – Non Golfers (R4500 + Vat R630) R5130.00Delegates – Golfers ( R5300 + Vat R742) R6042.00Delegates with Spouse – Non Golfers (R6250 + Vat 875) R7125.00Delegates with Spouse – Golfers x 1 (R7050 + Vat R987) R8037.00Delegates with Spouse – Golfers x 2 (R7850 + Vat R1099) R8949.00NON-MEMBERSDelegates Fee (R5850 + Vat R819) R6669.00Delegates Fee with Spouse (R7600 + Vat R1064) R8664.00Please Fax or Email your completed registration form and proof of payment to Nkgokeng Phetla. We will send you an invoice as soon as yourregistration form has been received for you to make payment. Please note that once an invoice has been forwarded to you, terms &conditions below will apply.Contact Details: Email: events@rfa.co.za Fax: 011-974 4903 Tel: 011-974 4399Banking details are as follows:The Road Freight AssociationFirst National Bank (FNB)Cheque Acc: 50416814123Branch Code: 252045Terms and ConditionsDelegates will be charged the full attendance fee if they cancel less than 3 weeks before the convention.Substitute names will be accepted.The above cancellation policy will even apply to registrations received less than 3 weeks before the convention.Payment must be received in full before the convention.The individual registering for the convention is personally liable for the payment and undertakes to makepayment for this event if his/her employer does not.I hereby agree to the payment requirements as listed above on this application.For and behalf of:________________________________Company Name________________________________Name in Block Letters_______________________Authorised SignaturePage 2 of 2