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Class of 1964 Reunion: 28-30 November 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, or fax: +27 (0)21 650 5010, email: joan.tuff@uct.ac.za
Your detailsName:
Address:
Email Telephone/mobile number:
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: 1964surname120098 eg 1964adams120098
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 +27 (0)86 612 6390 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 of card:
Expiry date:
Today’s date:
Class of 1964
Signature: …………………………………….
Fri, 28 Nov 11h45 Registration and Lunch, Mac Club, Medical School13h15 Tour of Medical 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, 29 Nov 8h30-12h30 Academic Meeting – Wolfson Pavilion Lecture Theatre, IDM Building
12h45 Lunch – foyer, IDM BuildingAfternoon At leisure18h30 for 19h00
Class photograph followed by Gala Dinner – Smuts Hall dining roomDress: Black Tie/Dark Suit or long evening dress
Sun, 30 Nov
09h00 Mountain walk led by Fay Thornley
12h00 Lunch – Rhodes Memorial Tea Room
Costs
Date Event Cost Number attending
Total
Fri, 28 Nov Registration (obligatory; per class member
only)R700.00 per classmate
R700.00
Lunch – Mac ClubCash bar available
R120.00 per person
Heart of Cape Town Museum, Groote Schuur Hospital: Adults
R50.00 per person
Cocktail Party - Foyer, IDM Building R140.00 per person
Sat, 29 Nov
Academic meeting – Wolfson Pavilion, IDM Building
No charge
Light Lunch – Foyer, IDM Building R120.00 per person
Gala Dinner – Smuts Hall dining hall R320.00 per person
Sun, 30 Nov
Lunch – Rhodes Memorial Tea Room Own account (indicate number
attending)
TOTAL PACKAGE (per class member): R1450.00 + Spouse / Partner R 570.00 =
R2200.00
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Class of 1964Please 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.
Name tags Classmate Partner
Name and Surname Name and Surname
Dietary preferences/allergies:
Walking disabilities:
Mountain Walk: Would you like to Fay Thornley on a mountain walk?
Yes No If yes, number attending
The following class members have agreed to speak:
Roger Melvill The Brain at AltitudeWarwick Morris Craniofacial SurgeryPaul Wilson Chinese Export Porcelain: It's the Story that MattersJudith Landau The ARISE Model: A Multigenerational Approach for Enhancing Family &
Community Connectedness, Prevention, Healing, And Engagement When Confronted With The Long-term Consequences Of Trauma
Dennis Huddleston
Rapid Recovery Knee Replacement Surgery
Chris Molteno Neural Correlates of Prenatal Alcohol ExposureRuth Wannenburg … of Aloes, Sangomas, Secrets and Things
Names of classmates who have indicated that they would like to attend thus far:Ivan Berkowitz, Ed Coetzee, John Colley, Jim Crosier, Herschel Flax, Philip Garratt, Annette Goosen, Dennis Huddleston, Dawood Khan, Martin Kift, Horst Kirsten, Johan Koeslag, Judith Landau, Peter Levin, Mike Mair, Roger Melvill, Milton Meyers, Wilfred Millin, Chris Molteno, Warwick Morris, Barry Munnik, Dennis North Coombes, Ian Osborn, Jonathan Peter, Gerald Riemer, Jonathan Scher, Alan Scher, Lewis Sparks, Fay Thornley (Linder), Peter Turner, Jan van den Ende, Glenifer van Hoogstraten, Gerda Veldman, David Walker, Ruth Wannenberg, Susan Wells, Dudley Werner, David Wheatley, Paul Wilson, Lionel Wolff.
Booklet forms received thus far - DEADLINE 17 OCTOBER (questionnaire on page 4)Ivan Berkowitz, Roy Cooke, Jim Crosier, Paul Du Plessis, Herschel Flax, Philip Garratt, Dennis Huddleston, Martin Kift, Johan Koeslag, Judith Landau, Peter Levin, Mike Mair, Roger Melvill, Wilfred Millin, Chris
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Class of 1964Molteno, Warwick Morris, Barry Munnik, Ian Osborn, Jonathan Peter, Gerald Riemer, Jonathan Scher, Lewis Sparks, Fay Thornley (Linder), Peter Turner, Jan van den Ende, Gerda Veldman, David Walker, Ruth Wannenburg, Dudley Werner, Paul Wilson, Lionel Wolff.
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Class of 1964
CLASS OF 1964
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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