REGISTRATION FORM

COURSE : CIV5110S LABORATORY AND FIELD TECHNIQUES 11th 15th July 2011

Title Institution / Company (as applicable)

Surname

First Name

Address

Tel Fax

Cell E-mail E-mail

Address invoice to:

Signature Date

FEES : Students : R 1200

Non Students : R 5000 (Exclusive of VAT)

Course fees to cover some administrative costs, course notes, tea and snacks.

Please make payment to: University of Cape Town, Standard Bank No. 1 Account 071503854, Rondebosch Branch Code: 025009. Quote ref: 402111 Kalumba

Once payment has been made, please fax copy of payment to 021 689 7471 Attention Elly, or send e-mail confirmation to Elly.Yelverton@uct.ac.za.

Closing date for applications: 4th July 2011