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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