Name *FirstLastProfessional / Practice Number *SANC/ HPCSA/ BHF Number to be inserted in this area.Email (copy) *Conference Fees *

• Active Member R1500
• Non Member R1800
• Other

Which day are you plan on attending? *

• 18th November 2022
• 19 Novemeber 2022
• Both days

Will you be staying overnight? *

• Yes
• No

If you staying overnight, are taking advantage of our conference Logistics/ Travel Agent ? *

• Yes
• No

Travel agent – https://www.navigatemytrip.com/Notifications

• I would like to receive email updates regarding future conferences

Comments or Questions WHASA MEMBER https://pay.yoco.com/r/2V15xk