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Surname  
Name (Husband)  
Email (Husband)  
Cell No. (Husband)  
Indicate Country of origin  
Have you paid Registration Fee?  
Will you be sleeping in Sun City or Outside Sun City  
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ACC/NO:  622 95 4632 95

   CHEQUE ACCOUNT

BANK CODE:  230 234
REF:  4th + surname + initials

Surname  
Name (Wife)  
Email (Wife)  
Cell No. (Wife)  
If You are from South Africa, indicate your Province  
If Sleeping in Sun City, Which hotel do you prefer?  
How many Nights?  

* PLEASE FILL AND SUBMIT BOTH FORMS BELOW TO REGISTER FOR THIS EVENT

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