PHASA 2023 - Exhibition Application Form

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Contact Person

First Name and Surname *

Business telephone *

Mobile *

Email address *

Invoicing Details

Organisation *

Postal address, including city and province *

Postal code or zip *

Country *

Full Name and Surname *

Email address *

Work telephone *

Country code number *

Mobile *

Country code number *

VAT number *

Exhibition Stand

Exhibition stand Package choice
*

Bronze - R25 000

Silver - R40 000

Gold - R65 000

Platinum - R100 000

Sponsorship Opportunities

Delegate Conference Bags - R 200 000

Lanyards and ID badges - R 20 000

Mini programmes - R 15 000

Sponsor prizes for best presentations - R10 000

Sponsor a tea break (will be branded in the programme as the “Sponsors name tea break”) - R50 000

Sponsor a lunch break (will be branded in the programme as the “Sponsors name lunch break.”) - R100 000

Co-sponsor the Gala Dinner (gala dinner will be branded in the programme as the “Sponsors name Gala Dinner.”) - R200 000

1. Company Representative (Full Name, Business Telephone & Email address)

2. Company Representative (Full Name, Business Telephone & Email address)

Number of Stands required

First stand preference

Second stand preference, if first is not available

Payment Method

Bank transfer

Credit Card

Clear selection

Payment Details

The organisers will not be responsible for identifying funds if organisations/companies do not include this in the reference for payment. Transfer are for the delegate's own account

South African Medical Research Council
ABSA Bank
Bank Account No. 90 6475 8975
Branch: ABS PBLCS W/C
Branch Code: 632 005
Swift Code: ABSAZAJJ

Please indicate the following references in order for the organisers to confirm your payment:
•Name of organisation/company

Submit

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