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This Registration form is for the ORTARChI Annual Gathering (25-27 October 2023)
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Please indicate which meetings you will be attending
*
ORTARChI Annual Gathering (25-27 October 2023)
ORTARChI Annual Gathering (25-27 October 2023)
CARGF Reflection and Foresight Convening (23-24 October 2023)
Both
(Tick one that applies as per prior communication)
Title
Prof
Prof
Dr
Ms
Mr
other
Surname
*
Full First Name/s
*
What name and surname would you like us to use in workshop-related documentation?
*
Gender
*
Female
Male
Non-binary
Prefer not to say
other
Nationality
*
Organisation
*
Job title / Designation
*
Preferred email address for communication
*
Mobile number including country code
*
(e.g. +27 12 345 6789 for South Africa)
First language
*
English
French
Portuguese
Please only select one
What role do you play in ORTARChI?
*
O.R. Tambo Africa Research Chairholder
Collaborator of O.R. Tambo Africa Research Chairholder
Host Institution research office representative
Research Chairholder support (office/ research manager)
Host institution leadership
Initiative partner
Advisory committee
SARChI guest
Invited guest (speakers, facilitator, science journalist)
other
Please select one
Do you require an invitation letter? (Yes/No)
*
Yes
Yes
No
Are you planning to attend the Dinner on 26 October? (Yes/No)
*
Yes
Yes
No
Special Requirements
Dietary requirements
*
No
Other, please state below
Please fill in if you chose other above
Do you require disability-related support? If so, please specify
Travel Arrangements (For sponsored delegates only as per prior communication)
In order for us to process your travel and accommodation, please complete this form BEFORE 15 September 2023. If you do not require flights, please skip this section.
Passport / ID number
Nationality as per passport / ID
Date of Arrival
Please indicate your preferred date of arrival IN Pretoria (Note: the NRF will cover your accommodation for the nights of 24, 25, 26 and 27 October 2023. Thus, if you elect to arrive in Pretoria prior to 24 October, accommodation will be at your own cost)
City of Departure
Name of Departure Airport
Please indicate your preferred date of departure FROM Pretoria (Note: accommodation is only covered until the morning of 28 October) Date of departure*
Date of Departure
Please indicate your preferred date of departure FROM Pretoria (Note: You have the option of departing anytime from the 28 October; however, accommodation is only covered until the morning of 28 October)
City TO which you will return
Airport TO which you will return
Accommodation
Do you require accommodation in Pretoria during the workshop?
*
Yes
No
Details of Next of Kin
To be contacted in case of emergency
Name and Surname
*
First
Last
Relationship to you
Contact number including country code
*
Email Address
Required Documentation
Upload a copy of your Passport/ South Africa ID (if based in South Africa)
Click or drag a file to this area to upload.
Submit Registration
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