You are welcome to either phone your credit card details through to Hester Pretorius (Manager, Finance) at +27-11-709-4698 or to use the online form below.

Ref number
First name *
Last name *
Contact Number *
E-mail Address *
Card Type *	VisaMastercard
Card Number *
Card Holder's Name *
CVV *	CVV - 3 digits at the back of the card
Expiry Date *	010203040506070809101112 20092010201120122013201420152016201720182019202020212022202320242025202620272028
Payment	R4000 registration fee + 14% VAT = R4560 R1000 student registration + 14% VAT = R1140 Please refer to comments below
Comments
	I confirm that the above information is correct. I authorise Mintek to debit my credit card for the total amount as specified on this form.
AntiSpam Code: *	( See image above, case sensitive )
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For further details, please contact the chairman of the conference organizing committee, Dr Roger Paul at RogerP@mintek.co.za