Register for the 2015 Robben Island Diversity Experience

 

Registration Form
Robben Island Diversity Experience: 01-06 November 2015

1. Full names:

 

2. I D Number (RS A Citizens)

 

3. Title:

 

4. Postal address:

 

5. City:

 

6. Postal Code:

 

7. Province/State:

 

8. Country:

 

9. Company/ Organization/ Institution:

 

10. Tel (w):

 

11. Fax

 

12. Mobile:

 

13. E-mail:

 
                 

The following particulars are necessary for ensuring diversity on the program.

14. Job Title:

 

15. Race:

 

16. Gender:

Male

Female

17. Any other diversity-related characteristics that you bring to the experience:

 

18. Is your current work directly related to diversity?

19. Do you have Group Relations Experience?

 

 

 

Yes

No

Yes

No

20. Do you want to apply to be part of the advanced group?

Yes

No

21. Please select the conference package you would like to register for

Dormitory

R 14 820.00 p.p

Twin room

R17 100.00p.p

Single room

R 18 240.00 p.p

 

For more information about RIDE contact Thembi Kgengwenyane or Marius Pretorius
thembi@tdcisa.co.za/ +27 12 326 2605+27 12 326 2605 / 087151061
marius@tdci.co.za/ +27 83 233 9936+27 83 233 9936
For an electronic registration form contact - thembi@tdcisa.co.za / 012 326 2605012 326 2605 / 0871510615.
E-mail registrations to admin@tdci.co.za or fax it to 086 6466 833