SPEAKER REGISTRATION FORMPlease enable JavaScript in your browser to complete this form. - Step 1 of 3TERMS & CONDITIONS - COMPULSORY TO READ BY REGISTERING FOR THE CONFERENCE, YOU ARE AGREEING TO THE FOLLOWING TERMS & CONDITIONS: NOTE: Should there be a COVID outbreak, there will be a full refund. 1- For the Member rates to apply, membership status will be verified before the quotation or invoice is emailed. 2- Invoices or quotations, if requested, will be emailed to delegates within 72 hours of registration. 3- Registration fees are to be paid in full prior to Conference date. 4- Non-payment or partial payment will result in access being denied to the Conference. 5- Delegates attending from outside South Africa are requested to make payment in South African Rands (ZAR) 6- Proof of payment, with the invoice number as beneficiary reference, is to be emailed to: finance@imesa.org.za 7- Registered Delegates who are unable to attend, can cancel in writing BEFORE 31 August 2023 at NO CHARGE via registration@imesa.org.za 8- Registered Delegates who have paid and cancel in writing AFTER 31 August 2023 are liable to pay a cancellation fee, R3 500. 9- Registered Delegates who DO NOT CANCEL in writing prior to the Conference, will be liable for the FULL DELEGATE FEE. 10- If a registered delegate cannot attend the conference, a name change can be requested in writing via registration@imesa.org.za It is the delegate's responsibility to ensure IMESA has the correct EMAIL ADDRESS as at 01 October 2023 for Conference updates and recording of attendance. Please notify conference@imesa.org.za if your email changes. I hereby confirm that I have READ AND AGREE to the Terms and Conditions of this Agreement as set out above which includes the cancellation and payment conditions. *YESNextDate of making this booking *BILLING INFORMATION This information will be used to generate an Invoice. LayoutDo you need a QUOTE? *YES, email me a QUOTENO, send me an INVOICECompany Name to appear on Quote OR Invoice *Company Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryVAT Number (if applicable)Name of person responsible for paying the account *FirstLastLayoutEmail *Phone *NextSPEAKER RATE : R5,250 (incl. VAT) Conference is CPD Accredited. Delegates can earn up to 2,5CPD points by attending ALL Sessions and a Technical Tour. MAIN SPEAKER INFORMATION We will use this information for all correspondence related to the Conference. Speaker name & surname *FirstLastPhone Number *Email Address *Designation *Are you employed by a Municipality?YESNOIf YES, Name of the Municipality in fullAre you an IMESA Member? *YESNOIf YES, what is the membership number?Which Technical Tour will you be attending? *CLOSED - reached capacityCLOSED - reached capacityCLOSED - reached capacityNONEDIETARY REQUIREMENTS *VegetarianHalaalNONEAttending - OPENING FUNCTION (Tuesday @ 18h00)?YESNOAttending - SOCIAL EVENING (Thursday @ 18h30)?YESNOLunch at the venue on FRIDAY @ 13h00?YESNOBOOK SEPARATELY FOR THE GOLF DAY / COMPANION PROGRAMME TRANSPORT / FREE SHUTTLE SERVICE IMESA will provide a FREE shuttle from the Airport to the Conference Venue and also run daily shuttles to and from selected Hotels listed on the conference website. A shuttle will also be available for the Thursday night Social Evening. Send an email to marketing@imesa.org.za to be included on the Transport communication that will be sent in September 2023. Submit