<p> REGISTRATION FORM Invitation to the Sanitation innovation and industrialisation: Business Breakfast Date: 16 September 2016 Venue : Innovation Hub, Pretoria Time: 08:00 – 12:00</p><p>Final date for submission 10 September 2016</p><p>Particulars of registration applicant, one form per person</p><p>1 Surname Title First Name Preferred Name Institution Designation</p><p>Mailing Address City Code Country Please add area Telephone codes to numbers Fax Mobile e-mail</p><p>DST Science seminar attendance 2 Mark with X </p><p>16 September Yes No</p><p>Dietary requirements 3 Diabetic Halaal Kosher Vegetarian Other – please specify:</p><p>By signing this form, I accept the Cancellation Policy, and Disclaimer.</p><p>4</p><p>Signature Date</p><p>CANCELLATION POLICY Notification of cancellation must be sent to the organisers in writing before 12 September 2016.</p><p>1</p><p>REGISTRATION APPLICATION FORM Please type personal information for registration submission by e-mail and send to Ms Carolina ROscigno, E-mail [email protected], Postal Address: Room 1338, Human Sciences Research Council, Private bag x41, Pretoria 0001</p><p>If no response has been received within 4 working days from date of registration submission, please enquire at Telephone: +27 (0) 12 302 2341</p><p>2</p>