Second International Islamic Retreat – Cape Town – 2011

Registration form – International Guests

Please fill out this registration form and send it by email to siir2011@isnet.za.net
NOTE: All information will be kept strictly confidential and not shared.
Personal information -
FULL NAME IN PASSPORT :
NAME (otherwise)
HOME ADDRESS

POSTAL ADDRESS
EMAIL ADDRESS
TELEPHONE CONTACT NUMBER:
MOBILE CONTACT NUMBER:
NEXT OF KIN NAME AND
CONTACT NO. IN CASE OF
EMERGENCY:
NATIONALITY IN PASSPORT
COUNTRY OF ORIGIN
PASSPORT NUMBER &
ID/Social security Number:

Place X in applicable box -

Gender : Male ( ) Female ( )
Age: UNDER 20 [___] UNDER 30 [___] UNDER 40 [__]
UNDER 50 [___] OVER 50 [___]
Marital Status: Married [__] Single [____] Divorced [____]
Occupation
Qualifications
Special Interests
Where did you
learn about retreat
Health:

Do you have any medical problems or chronic conditions that we should be aware of and for
which you may require medical assistance during the Retreat?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
__________________________________________________________________________

Travel information -
1.a) ROUTE TO CAPE TOWN: [eg via Dubai, Johannesburg, Cape Town]
_____________________________________________________________________________
_ 1.b) ROUTE FROM CAPE TOWN :
_____________________________________________________________________________
_
2. FLIGHT NUMBER, DATE AND TIME OF ARRIVAL IN CAPE TOWN
_____________________________________________________________________
3. FLIGHT NUMBER, DATE AND TIME OF DEPARTURE FROM CAPE TOWN

Countries requiring VISAs: http://www.dha.gov.za/visa_schedule.asp

VISA Costs and Procedure: http://www.dha.gov.za/visa_detail.asp
*Those who require visas should let us know what they need from us in order to apply for visas:
Meals -
Free meals will be provided for all, please indicate any special dietary requirements:

Registration Fee
Should you wish to stay over with us a fee of US$40 per person is payable for the week, this
includes dormitory style accommodation. If you cannot afford the fees, please request
sponsorship below.
Mark your choice with X:
Sleep over 7 days @ US$40 [____] Sponsorship requested (y/N): [____]
Willing to sponsor others – indicate amount $[_____]

Accommodation:
Which of these will best suit you (check/X to select ) – 1 [_____] 2 [_____]

1] Dormitory style [i.e. sharing a common space]

Separate dormitory accommodation for males and females, double bunks, 60 people per cabin,
with showers and toilets. This option is provided at no extra cost to attendees. The retreat is
about getting to know each other, unless you have your family with you, this is the best option.

2] Private Chalet’s for couples and families, 2 Daily shuttles to and from Retreat site, nearby
train service as well. Costs are for your own account, we will quote you according to your
requirements.

Retreat information -
Kindly send us a brief bio-data with information concerning your studies in Islam and
specialization in subjects pertaining to Islamic Studies - including recitation of the Qur'ān. We
would like to enrich the Retreat by utilizing resources available amongst participants.

Imran N. Hosein:
How familiar are you with the thought and published works of Imran N. Hosein?
Unfamiliar [___] Basic [___] Medium [____] Good [____] Excellent [___]

Have you read the following of his books which are available for free download on his website ?
(www.imranhosein.org):
- Jerusalem in the Qur'ān,
- Sūrah al-Kahf and the Modern Age,
- An Islamic View of Gog and Magog in the Modern Age, and
- The Gold Dinār and Silver Dirham - Islam and the Future of Money?

Other activities -
Would you like to spend a little time in:
sports [___] shopping [___] sightseeing [___] meeting people [___] other activities [____]
Simons Town

The second week of the retreat will be conducted at a resort in Simons Town, Cape Town.
All accommodation costs will be shared by you. Tours and outings have also been arranged on a
cost sharing basis. We will cook our own food and share the cost of this as well.
Ml Imran Hosein and his wife, Aeysha, will be staying with us, along with some invited Ulema.
During this time there will be intimate, informal lessons conducted twice a day. Costs will be
confirmed at a later time, but will be kept to a minimum.

Please indicate if you are attending.

Attending [____] Number of Days (out of 7) [__]

If you are travelling with your family please indicate the number of beds for the second week :
[____]

To help us to optimise planning of the tours please indicate which activities you are interested in.

[ ] Hiking [ ] Museums [ ] Boat Trip [ ] Shopping [ ] Cultural Tours

[ ] Sight Seeing [ ] [ ] Shark Cage Diving