23 - 25 November 2020
WITS MINING INSTITUTE, CHAMBER OF MINES BUILDING,
 WEST CAMPUS, WITS UNIVERSITY.
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Title *
Your first name/s *
Your surname *
Date of birth *
MM
/
DD
/
YYYY
 Your Identity Number/ Passport Number *
Your country (if not from SA) *
Your email address *
Your gender
Your institution/ organisation *
Postal address
Postal Code
Your cell phone number *
Highest qualification *
Required
Dietary requirements *
Required
Disability *
Certificate Address *
Physical address where your certificate can be couriered
Your course type *
Required
Payment Details: Payment to be made by electronic transfer/ deposit into the following account:
Bank: First National Bank
Name of Account: University of Witwatersrand, Faculty of Engineering & Built Env.
Account Number: 62150130260
Type of Account: Current
Branch Name: Corporate Account Services, Johannesburg
Branch Number: 255005
Date of payment *
MM
/
DD
/
YYYY
If Sponsor or Company paying your fees, please complete the details below and they will receive the invoice
Company/Sponsor Name
Company/Sponsor Address
Person responsible for payment (Name)
Person's email address
Company telephone number
Company VAT Number
Invoice type
PLEASE NOTE WE HAVE LIMITED SEATS AVAILABLE
Kindly send your proof of payment and/or any queries to the following email address.

Email: Lileen.Lee@wits.ac.za   
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