Class of 1989 Reunion: 5-7 December 2014

REGISTRATION FORMPlease complete this form and return it with your payment, by not later than 17 OCTOBER 2014 and return to:Joan Tuff, Alumni & Bequest Officer, UCT Faculty of Health Sciences, Anzio Road, Observatory, 7925.Telephone: +27 (0)21 406 6686, Fax: +27 (0)21 650 5010 or +27 (0)86 612 6390, Email: joan.tuff@uct.ac.za

Your detailsName:

Address:

Email Telephone/mobile numbers:

Your payment South African Rands please Tick your preferred payment method

1. cheque (payable to “UCT”)

2. direct (EFT) depositsBank: Standard Bank of South Africa, RondeboschAccount name: UCT Sundries AccountBranch Code: 025009 Account Number: 071 503 854Type of Account: CurrentReference: 1989surname120098 eg 1989adams120098

3. internet banking Same as direct deposits Swift code SBZAZAJJ (foreign payments) – please include bank charges with your payment

For payment methods 2 or 3, forward a copy of your deposit slip by fax or email to Joan TuffFax +27 (0) 650 5010 or Email: joan.tuff@uct.ac.za

4. credit card Authority for payment by CREDIT CARD to the University of Cape TownPlease debit my American Express MasterCard Visa Other:

Amount:

Card number

Last three digits on back:

Expiry date:

Today’s date:

Signature ……………………………………

Class of 1989

Fri, 5 Dec 11h45 Registration and Lunch, Mac Club, Medical School13h15 Tour of Med School15h00 Tour of the Heart of Cape Town Museum, Groote Schuur Hospital18h00 Cocktail party – Institute of Infectious Disease & Molecular Medicine

(IDM building), Medical School Dress: Smart casualSat, 6 Dec 08h30-12h30 Academic Meeting – Wolfson Pavilion, IDM Building, Medical School

12h45 Lunch – foyer, IDM BuildingAfternoon At leisure18h30 for 19h00

Class photograph at 18h45 followed by Gala Dinner – Smuts Hall dining roomDress: Jacket &Tie/Suit

Sun, 7 Dec 08h30 Mountain walk with Caro Nel10h30 Guided tour of Kirstenbosch Gardens12h00 Family Picnic – Kirstenbosch Gardens

Costs

Date Event Cost Number attending

Total

Friday5 December

Registration (obligatory; per class member only) R700.00 per

classmateR700.00

Lunch – Mac ClubCash bar available R120.00 per

person

Heart of Cape Town Museum Hospital:AdultsScholars

R50.00 per person

R25.00 per person

Cocktail Party - Foyer, IIDMM BuildingCash bar available R140.00 per

personSaturday6 December

Academic meeting – Wolfson Pavilion, IDM Building No charge

Light Lunch – Foyer, IIDMM Building R120.00 per person

Gala Dinner – Graça Michel dining hallCash bar available R320.00 per

personSun, 7 Dec *Guided Tour of Kirstenbosch Gardens R45.00 per

person

*Picnic - Kirstenbosch Gardens - With ½ bottle of red or white wine (circle) Without wine Kiddies

R185.00 per person

R155.00 per person

R 80.00 per person

* Entrance fee for own account on the day

TOTAL PACKAGE (per class member): R1680.00 + Spouse / Partner R 980.00 =

R2660.00

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Class of 1989

Please note: In the event of a cancellation, a cancellation fee will be levied. Refunds may only be accommodated if confirmations for expenses such as catering, printing, photography, etc have not yet been made. Your understanding would be greatly appreciated.

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Class of 1989

Name tags

Classmate Partner

Name and Surname Name and Surname

Dietary preferences/allergies:

Mountain Walk: Would you like to join Caro Nel on a mountain walk?

Yes No If yes, number attending

Academic meeting

The following class members have already agreed to speak:

Sandy Inglis UCT to UtopiaIngrid Landman The Zimbabwe ExperienceHelen Raynham Private Practice in the USA and Change with ObamacareCamilla Kingdon Can we Help Medical Students Make Sensible Career Decisions or is it all About

Chance?Stuart Dwyer Vitamin D and the 33rd DegreeGuy Henderson The Stresses of our ProfessionSusan Bigby Endometrial CancerPaul Hersch Cardiac Surgery – A Patient Perspective

Names of classmates who have indicated that they would like to attend thus far:Stuart Baines, Tracey Bergstrom, Susan Bigby, Anton Boonzaier, Andrew Burns, Walter Douie, Michele Dupont, Stuart Dwyer, Bridget Farham, Lorraine Forbes, Susan Hall (Denton), Mark Harrison, Toni Hatfield (van Lennep), Guy Henderson, Alison Henry, Paul Hersch, Kate Hodge, Sandy Inglis, Camilla Kingdon, Ingrid Landman, Mike Marshall, Gavin Martin, Michele Matter, Brian Morgan, Caro Nel (Jardine), Helen Raynham, Tracy Robinson, Guy Rousseau, Bettina Schon (Taylor), Paul Skoll, Dot Smyth, Anne Sumner, Michael Tavares, Michele van Niekerk, Carol Willies, Alan Wood.

Booklet forms received thus far - DEADLINE 17 OCTOBER (questionnaire on page 4)Seymour Atlas, Stuart Baines, Susan Bigby, Anton Boonzaier, Andrew Burns, Stuart Dwyer, Bridget Farham, Lorraine Forbes, Susan Hall (Denton), Mark Harrison, Toni Hatfield (van Lennep), Guy Henderson, Alison Henry, Paul Hersch, Kate Hodge, Sandy Inglis, Camilla Kingdon, Trish Lück, Mike Marshall, Gaviin Martin, Claus Migeod, Brian Morgan, Carolyn Nel, Jeff Peimer, Brodyn Poulton, Helen Raynham, Tracy Robinson, Guy Rousseau, Paul Skoll, Bruce Smith, Dot Smyth, Carol Willies, Alan Wood.

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Class of 1989

CLASS OF 1989

The Reunion Booklet – IF NOT ALREADY COMPLETED

Please complete this part whether you are attending the reunion or not. Fill in the table below by TYPING in each answer. Be brief and include an ID size photograph as an attachment. Save the form as a word document, not a PDF, so that it can be copied and pasted into the booklet.

The completed form should be no longer than one page. Please note that you do not have to hit enter when filling in the form; the spacing will adjust automatically at the end of each line, therefore just click in each blank cell and type the individual answer. Please do not move or adjust the table or change the pre-set fonts.

NameHome address

Code & countryTelephone (home)

FaxTelephone (work)

FaxMobileEmail

Place of employment (if now retired, state last

position held)Field of Practice

Actual Job DescriptionDegrees (post grad)What have you been

doing since you graduated?

Tell us about your wife/partner, children

and grandchildrenHobbies, interests and

sportsAchievements/Awards

Life’s memorable moments

Would you have any objection to this information being published in a UCT publication? YES NO(we will not divulge your contact details)

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