Online Registration – ORTARChI Annual Gathering – SGCI

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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 *

(Tick one that applies as per prior communication)

Title

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) *

Are you planning to attend the Dinner on 26 October? (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? *

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.