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Registration

NOTE: All fields are compulsory. If a field is not applicable, mark it as n/a.
Personal Information
First name
Last name
Date of Birth
Gender
Marital Status
Occupation
Passport number
Issue date
Expiry Date
Place of Issue
Passport Country
RSA ID number
Contact Information
Telephone numbers
Home
Work
Mobile
Fax
E-mail address
Residential address





Postal address





Next of Kin
First name
Last name
Relationship
Country of Residence
Telephone numbers
Home
Work
Mobile
Fax
E-mail address
Church
Name
City/Town
Name of Pastor
Contact Number
E-mail address
Three steps to register

1. Complete the registration form (Online or download in Word Format or PDF Format.)
2. Make your payment (R 450.00) by bank transfer or direct deposit - with your surname and initials as reference.

ABSA Bank, Account name: Namrock, Account number: 9181 1643 70, Branch code: 632005.

3. Email or fax your Registration Form (If you didn't register online), Proof of Payment and your Medical/Travel Insurance Policy.

E-mail: registration@namrock.co.za
Fax: 0866-524-289 in South Africa or +61-2-9012-0315 for International faxes
The NamRock-team will confirm your registration.

Important Registration Information

Registrations close 12 pm Wednesday 9th of June, or when fully booked.
Late Registrations close: Sunday 13 June 2010 (No Welcome Pack, T-shirt or Travel insurance option)

Please note:
Registration Fee is R 450.00 per person which includes your meals, camping fees, a NamRock T-Shirt, a NamRock CD and all the arrangements for the program. (It does not include drinks, transport, medical/travel insurance, your camping gear like tents, eating utensils and other items indicated on the checklist.)

Confirmation of registration is only when your Registration Form, Payment and Travel Insurance Policy is received, processed and confirmed.

Travel/Medical insurance cover for Namibia for the duration of the NamRock weekend is compulsory.
We can take out limited cover from AIG Assist at R100 per person for the weekend which covers treatment in Namibia only. Indicate in your Registration Form if you need this.

Registration Cancellation fees are:
20% up to 9th of June 2010.
100% after 9th of June 2010. (If transferred to another person we might not be able to change T-shirt size)

Transfer of registrations to another person is only possible on prior arrangement with the organizers at a R40 administration fee.

Medical Insurance
I have medical/travel insurance cover for Namibia and will email/fax the policy certificate with contact numbers to you
I don’t have any and want you to take out for me at a cost of R100 for the weekend. (Please note that this will cover you for treatment in Namibia only)
Special medical conditions
Transport
I am travelling from
I have my own transport
T-Shirt
Style
Your size
Sign me up for fun in the


ACKNOWLEDGEMENT OF RESPONSIBILITY AND RELEASE OF LIABILITY
I agree that all the information provided in this form is true and correct and I agree to the conditions of registration and cancellation. I agree to abide by the spirit, rules and programme of the NamRock celebration weekend.
I/We do hereby release the NamRock organisers, representatives, agents, and volunteer assistants from any liability whatsoever arising from an injury, theft, damage, disability or loss of health, property, emotional stability or life, which may be sustained by said person during the course of involvement and participation in the NamRock celebration weekend.
NOTE: By submitting this form you agree to the terms and conditions specified above.

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