Accommodation form - University of the Free State

Accommodation form
Title:
Surname:
Full Name:
Address 1:
P.O. Box:
Address 2:
Suburb:
Suburb:
Town:
Town:
Country:
Country:
Postal code:
Postal code:
E-mail:
Telephone nr:
Affiliation:
Nights booked:
27 September 2009
01 October 2009
28 September 2009
02 October 2009
29 September 2009
03 October 2009
Amount paid:
Reference:
1 151 59531,
Accommodation information:
1. Please make an electronic payment before 31 July 2009 via your bank/internet into the following
account:
Bank: ABSA
Branch: Public Sector
Branch code: 630 734
Account name: University of the Free State
Account number: 1570 850071
Swift code: ABSAZAJJ
Type of account: Cheque
NB: As reference, fill in 1 151 59531 plus your initials and surname on the deposit slip.
2. Complete the form above.
2. Please e-mail or fax the form above to:
St George Vis
Department of Afroasiatic Studies, Sign Language and Language Practice
IB 37
P.O. Box 339
University of the Free State
Bloemfontein
E-mail: [email protected]
Phone: +27 51 401 9687.
Fax: +27 51 401 3511
All information supplied will be treated in strict confidence
* Your specified name(s) must be in accordance with official documents i.e. passport. Failure to do so
may cause delay in the process of visa application, tuition fee payment, and course registration.