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.
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