Details of Person Registering Company for Event

First Name*
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Field is required!
Last Name*
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Field is required!
E-mail Address*
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Field is required!

Details of Company

Name of Company as Registered on CIPC*
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Field is required!
Company Trading Name (If Different From Registered Name)
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Field is required!
Company Registration Number*
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Field is required!
Location of Company Head Quarters*
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Field is required!

Operational Area (Tick All Appropriate Boxes) *

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Field is required!

Names of Directors

DIRECTOR 1

First Name*
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Field is required!
Middle Name
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Field is required!
Last Name*
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Field is required!
Cellular Number 1*
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Field is required!
Cellular Number 2
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Field is required!
Office Tel Number
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Field is required!
E-mail Address*
Enter Valid E-mail Address
Enter Valid E-mail Address

EXECUTIVE PA / SECRETARY 1

First Name
Field is required!
Field is required!
Middle Name
Field is required!
Field is required!
Last Name
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Field is required!
Cellular Number 1
Field is required!
Field is required!
Cellular Number 2
Field is required!
Field is required!
Office Tel Number
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Field is required!
E-mail Address
Field is required!
Field is required!

DIRECTOR 2

First Name
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Field is required!
Middle Name
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Field is required!
Last Name
Field is required!
Field is required!
Cellular Number 1
Field is required!
Field is required!
Cellular Number 2
Field is required!
Field is required!
Office Tel Number
Field is required!
Field is required!
E-mail Address
Field is required!
Field is required!

EXECUTIVE PA / SECRETARY 2

First Name
Field is required!
Field is required!
Middle Name
Field is required!
Field is required!
Last Name
Field is required!
Field is required!
Cellular Number 1
Field is required!
Field is required!
Cellular Number 2
Field is required!
Field is required!
Office Tel Number
Field is required!
Field is required!
E-mail Address
Field is required!
Field is required!

DIRECTOR 3

First Name
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Field is required!
Middle Name
Field is required!
Field is required!
Last Name
Field is required!
Field is required!
Cellular Number 1
Field is required!
Field is required!
Cellular Number 2
Field is required!
Field is required!
Office Tel Number
Field is required!
Field is required!
E-mail Address
Field is required!
Field is required!

EXECUTIVE PA / SECRETARY 3

First Name
Field is required!
Field is required!
Middle Name
Field is required!
Field is required!
Last Name
Field is required!
Field is required!
Cellular Number 1
Field is required!
Field is required!
Cellular Number 2
Field is required!
Field is required!
Office Tel Number
Field is required!
Field is required!
Your E-mail Address
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Field is required!

You will receive a confirmation email after submission containing further instructions

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