Form

Secretariat SADC-CDE: c/o BOCODOL, P/Bag BO 187, Bontleng, Gaborone, Botswana
e-mail vmaika@bocodol.ac.bw Tel: 00267 3180094/ 00267 3646078 Fax: 0026 3191089 Mobile: 267 72509335

47th Distance Education Association of Southern Africa: Conference and Annual General Meeting

Conference Theme: Promoting Advocacy for Open and Distance Learning (ODL) in the SADC Region
Conference Dates: 21st – 23rd September 2012
Conference Venue: Swakopmund, Namibia

The conference fees are as follows (mark appropriate box):
	DEASA Member - SAR and 650 (USD 95) Non Member - SAR and 750 (USD 110) Student - SAR and 300 (USD 45)

Surname:
First name:
Name for the badge:
Gender
Title: (Prof., Dr. Mr., Mrs, Ms)
Country:
Organisation/Institution:
Position/Title:
Telephone/Mobile No.:
Postal address:
Fax:
E-mail address:

In what capacity do you attend? (Please tick in the appropriate box)
	Delegate Student Invited Speaker/Guest Organising Committee member

Special dietary requirements (Please tick in the appropriate box)
	Vegetarian No Beef No Pork No Sea food
Other (Specify):

Bank details:	Bank: Standard Bank Account Name: Distance Education Association of Southern Africa (DEASA) Account No: 012 135 224 Branch Code: 011545 Swift Code: SBZAZAJJ PLEASE NOTE: Fax or e-mail this registration form together with proof of payment to: Fax: 00 264 61 216 987; E-mail: Deasaloc@namcol.edu.na Also bring the original registration form and proof of payment to the conference for verification. The registration form should reach the Local Organising Committee Secretariat on or before 31st July 2012.