Registration Form

Lotsha Online Registration Form
Title:		Address:
First Names:
Surname:
Date of Birth:
ID Number:		Postal Code:
Home Language:

Cell:		Telephone (w):
Telephone (h):		E-mail:
Occupation:

Payment has been made by:		Banking Details:
	No Charge Workshop Direct Deposit - will fax copy to 0866-130-131 Electronic transfer - proof to follow via email or fax Credit Card Payment (Click here to make payment)		Account name: Lotsha Ministries Bank: Nedbank (Northgate) 169-805 Account No: 1698-064098

Please select the Conference or Workshop below which you would like to attend

Conferences & Workshops		Dates	Price
	Cape Town - Our Offenders, Our Victims, Our Responsibility Conference (A R30 Donation towards refreshments & Lunch would be appreciated)	20 February 2010	No Charge
Please enter the number shown in the image below: (Please call 0861-568-742 if you require assistance)
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