Full registration
  1. Title(*)
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  2. First Name(*)
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  3. Surname / Last Name:(*)
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  4. Profession:(*)
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  5. Affiliation / Institution:(*)
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  6. Country(*)
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  7. E-mail address(*)
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  8. Partner joining(*)
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  9. Partner/Spouse details (Title, First Name, Surname/Last Name)
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  10. Registration details

  11. Special dietary requirements (Delegate) : (*)
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  12. Special dietary requirements (Partner): (*)
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  13. Registration fees (2 – 4 December 2017):
    Including tea/coffee & luncheons

  14. Specialists / and other physicians:
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  15. Registrars, Fellows, Trainees, Nurses and others:
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  16. Partners and Spouses attending lectures (non-medical):
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  17. Invited Faculty:
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  18. For catering purposes,
    please indicate your attendance:

  19. Saturday 2 December 2017

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  20. Sunday 3 December 2017
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  21. Monday 4 December 2017


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  22. Social events

  23. Saturday 2 December: Welcome “Meet and Greet” Reception:
  24. Welcome “Meet and Greet” Reception(*)

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  25. Welcome “Meet and Greet” Reception (Partner)(*)

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  26. Sunday 3 December: “Courage and Innovation” Gala Dinner:
  27. Courage and Innovation Gala Dinner(*)

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  28. “Courage and Innovation” Gala Dinner (Partner)(*)

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  29. Amount payable

  30. Delegate:(*)
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  31. Partner/Spouse:(*)
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  32. Social functions:(*)
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  33. TOTAL: (ZAR)(*)
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  34. Payment options

  35. Choose Payment Option
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  36. Name of Account: Heart Transplant
    Bank: ABSA
    Account No: 9326659572
    Branch Code: 632005
    Swift/IBAN Code: ABSA ZA JJ
    Address: Absa Bank Limited, 180 Commissioner Street,
    Johannesburg, South Africa



  37. Thank you for choosing the Credit Card payment method

    Once you have completed the registration and clicked on the submit button your 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 "Pay Now" button. Once you have clicked on the button you will be redirected to Payfast for secure online credit card transactions.



  38. Seating is limited.

    Confirmation of registration will only be forwarded once the completed registration form has been submitted to the Congress Secretariat with the supporting proof of payment.

    For further information or assistance with registration, flights, accommodation, transfers, tours and excursions, please contact: Sonja du Plessis at Londocor Event Management: Tel: +27 82 455 7853 or e-mail sonja@londocor.co.za

    Cancellation Policy: Notice of cancellation must be given in writing. Any cancellations received before 30 September will be charged a 15% penalty fee. Any cancellations received after this date will result in a 100% cancellation fee.

  39. anti-spam(*)
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