Register For Event | Re A Vaya: Business Breakfast
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| Personal
Details (All fields marked with a * are required) |
| Title* |
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| Name* |
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| Surname* |
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| Date of birth* |
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| Marital Status |
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| Cell Number* |
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| Telephone Number* |
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| Fax |
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| Email* |
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| Employment
Details |
| Industry in which you work |
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| Company Name |
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| Your Designation |
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| Church
Details |
Where / how did you hear about HMM |
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| Religion |
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Church
Where You are From |
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City Where Church
Located |
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| Have you completed or done the
following: |
| R 300 per person |
Payment via Cash Deposit or EFT only. Please ensure that we receive your proof of payment as no registration will be confirmed without proof thereof.
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| Amount Already Paid* |
R
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| NOTICE |
Please ensure that you use the correct bank account details as supplied below |
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Please note the following
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HMM Banking details
Account Name:
Hebrew Midwives Ministry
Bank: Standard Bank (Rosebank Branch)
Bank Code: 051001
Bank Account Number: 002017628
Reference: YOUR NAME & SURNAME
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Your place is not booked until we received the proof of
payment |
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