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elementskit-section-title-wraper text_center ekit_heading_tablet- ekit_heading_mobile-"><h1 class="ekit-heading--title elementskit-section-title ">Registration Form</h1> <div class='ekit-heading__description'> <p>Early bird closing on 31 May 2025</p> </div> </div></div> </div> </div> </div> </div> <div class="elementor-element elementor-element-701a303 e-flex e-con-boxed e-con e-parent" data-id="701a303" data-element_type="container" data-settings="{"ekit_has_onepagescroll_dot":"yes"}"> <div class="e-con-inner"> <div class="elementor-element elementor-element-87abf10 elementor-widget elementor-widget-formidable" data-id="87abf10" data-element_type="widget" data-settings="{"ekit_we_effect_on":"none"}" data-widget_type="formidable.default"> <div class="elementor-widget-container"> <div class="frm_forms with_frm_style frm_style_formidable-style" id="frm_form_2_container" data-token="7526b91b2a033eef14a4adeceb42bcc9"> <form enctype="multipart/form-data" method="post" class="frm-show-form frm_pro_form " id="form_earlybirdregistration" data-token="7526b91b2a033eef14a4adeceb42bcc9"> <div class="frm_form_fields "> <fieldset> <legend class="frm_screen_reader">Early Bird Registration</legend> <div class="frm_fields_container"> <input type="hidden" name="frm_action" value="create" /> <input type="hidden" name="form_id" value="2" /> <input type="hidden" name="frm_hide_fields_2" id="frm_hide_fields_2" value="" /> <input type="hidden" name="form_key" value="earlybirdregistration" /> <input type="hidden" name="item_meta[0]" value="" /> <input type="hidden" id="frm_submit_entry_2" name="frm_submit_entry_2" value="e2bbcc89b0" /><input type="hidden" name="_wp_http_referer" value="/registration-form/" /><input type="hidden" name="item_meta[6][2]" id="field_c7cho-2" value="Unpaid" data-frmlimit="1" data-frmval="{"2":"Unpaid"}" data-invmsg="Registration Status is invalid" /> <div id="frm_field_7_container" class="frm_form_field frm_section_heading form-field "> <h3 class="frm_pos_top frm_section_spacing">Delegate Information</h3> <div id="frm_field_8_container" class="frm_form_field form-field frm_required_field frm_top_container frm_sixth"> <label for="field_7jgjn" id="field_7jgjn_label" class="frm_primary_label">Title <span class="frm_required" aria-hidden="true">*</span> </label> <select name="item_meta[8]" id="field_7jgjn" data-sectionid="7" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Title is invalid" aria-invalid="false" > <option value="Dr">Dr</option><option value="Prof">Prof</option><option value="Mr">Mr</option><option value="Ms">Ms</option><option value="Mrs">Mrs</option> </select> </div> <div id="frm_field_9_container" class="frm_form_field form-field frm_required_field frm_top_container frm6 frm_first"> <label for="field_gedl" id="field_gedl_label" class="frm_primary_label">First Name <span class="frm_required" aria-hidden="true">*</span> </label> <input type="text" id="field_gedl" name="item_meta[9]" value="" data-sectionid="7" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Text is invalid" aria-invalid="false" /> </div> <div id="frm_field_10_container" class="frm_form_field form-field frm_required_field frm_top_container frm6"> <label for="field_3krlo" id="field_3krlo_label" class="frm_primary_label">Surname (Last Name) <span class="frm_required" aria-hidden="true">*</span> </label> <input type="text" id="field_3krlo" name="item_meta[10]" value="" data-sectionid="7" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Text is invalid" aria-invalid="false" /> </div> <div id="frm_field_11_container" class="frm_form_field form-field frm_required_field frm_top_container frm6 frm_first"> <label for="field_dzamc" id="field_dzamc_label" class="frm_primary_label">Email Address <span class="frm_required" aria-hidden="true">*</span> </label> <input type="email" id="field_dzamc" name="item_meta[11]" value="" data-sectionid="7" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Email is invalid" aria-invalid="false" /> </div> <div id="frm_field_12_container" class="frm_form_field form-field frm_required_field frm_top_container frm6"> <label for="field_ufbp9" id="field_ufbp9_label" class="frm_primary_label">Contact Number <span class="frm_required" aria-hidden="true">*</span> </label> <input type="text" id="field_ufbp9" name="item_meta[12]" value="" data-sectionid="7" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Phone is invalid" aria-invalid="false" aria-describedby="frm_desc_field_ufbp9"/> <div class="frm_description" id="frm_desc_field_ufbp9">Cell Number / Work Number</div> </div> <div id="frm_field_13_container" class="frm_form_field form-field frm_required_field frm_top_container frm6 frm_first"> <label for="field_phtbe" id="field_phtbe_label" class="frm_primary_label">Profession <span class="frm_required" aria-hidden="true">*</span> </label> <input type="text" id="field_phtbe" name="item_meta[13]" value="" data-sectionid="7" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="[field_name] is invalid" aria-invalid="false" /> </div> <div id="frm_field_14_container" class="frm_form_field form-field frm_top_container frm6"> <label for="field_ea2r4" id="field_ea2r4_label" class="frm_primary_label">HPCSA/SANC/CEU Number (If Applicable) <span class="frm_required" aria-hidden="true"></span> </label> <input type="text" id="field_ea2r4" name="item_meta[14]" value="" data-sectionid="7" data-invmsg="Text is invalid" aria-invalid="false" aria-describedby="frm_desc_field_ea2r4"/> <div class="frm_description" id="frm_desc_field_ea2r4">Complete Number Required eg. MP0123456/SANC12345678</div> </div> <div id="frm_field_15_container" class="frm_form_field form-field frm_required_field frm_top_container frm6 frm_first"> <label for="field_zjxvb" id="field_zjxvb_label" class="frm_primary_label">Country <span class="frm_required" aria-hidden="true">*</span> </label> <select name="item_meta[15]" id="field_zjxvb" data-sectionid="7" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Country is invalid" aria-invalid="false" > <option value="South Africa">South Africa</option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="Bahamas">Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia Herzegovina">Bosnia Herzegovina</option><option value="Botswana">Botswana</option><option value="Brazil">Brazil</option><option value="British Virgin Islands">British Virgin Islands</option><option value="Brunei Darussalam">Brunei Darussalam</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cabo Verde">Cabo Verde</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Rep">Central African Rep</option><option value="Chad">Chad</option><option value="Channel Islands">Channel Islands</option><option value="Chile">Chile</option><option value="China">China</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Congo {Democratic Rep}">Congo {Democratic Rep}</option><option value="Costa Rica">Costa Rica</option><option value="Cote d鈥橧voire">Cote d鈥橧voire</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Curacao">Curacao</option><option value="Cyprus">Cyprus</option><option value="Czechia">Czechia</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="East Timor">East Timor</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Eswatini">Eswatini</option><option value="Ethiopia">Ethiopia</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Polynesia">French Polynesia</option><option value="Gabon">Gabon</option><option value="Gambia">Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Isle of Man">Isle of Man</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Ivory Coast">Ivory Coast</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="Korea Rep.">Korea Rep.</option><option value="Korea Dem.">Korea Dem.</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyz Republic">Kyrgyz Republic</option><option value="Lao PDR">Lao PDR</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macao SAR">Macao SAR</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Northern Mariana Islands">Northern Mariana Islands</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russian Federation">Russian Federation</option><option value="Rwanda">Rwanda</option><option value="St Kitts & Nevis">St Kitts & Nevis</option><option value="St Lucia">St Lucia</option><option value="St. Martin">St. Martin</option><option value="Saint Vincent & the Grenadines">Saint Vincent & the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome & Principe">Sao Tome & Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Sint Maarten">Sint Maarten</option><option value="Slovak Republic">Slovak Republic</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="South Sudan">South Sudan</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Swaziland">Swaziland</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syrian Arab Republic">Syrian Arab Republic</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tonga">Tonga</option><option value="Trinidad & Tobago">Trinidad & Tobago</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="United States">United States</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="Virgin Islands (U.S.)">Virgin Islands (U.S.)</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option> </select> </div> <div id="frm_field_16_container" class="frm_form_field form-field frm_required_field frm_top_container frm6"> <label for="field_8iqqb" id="field_8iqqb_label" class="frm_primary_label">Province <span class="frm_required" aria-hidden="true">*</span> </label> <select name="item_meta[16]" id="field_8iqqb" data-sectionid="7" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Province is invalid" aria-invalid="false" > <option value="Eastern Cape">Eastern Cape</option><option value="Free State">Free State</option><option value="Gauteng">Gauteng</option><option value="KwaZulu-Natal">KwaZulu-Natal</option><option value="Limpopo">Limpopo</option><option value="Mpumalanga">Mpumalanga</option><option value="Northern Cape">Northern Cape</option><option value="North West">North West</option><option value="Western Cape">Western Cape</option> </select> </div> <div id="frm_field_17_container" class="frm_form_field form-field frm_required_field frm_top_container frm_half"> <label for="field_wsxam" id="field_wsxam_label" class="frm_primary_label">Dietary Requirement <span class="frm_required" aria-hidden="true">*</span> </label> <select name="item_meta[17]" id="field_wsxam" data-sectionid="7" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Dietary Requirement is invalid" aria-invalid="false" > <option value="None">None</option><option value="Vegetarian">Vegetarian</option><option value="Vegan">Vegan</option><option value="Halaal">Halaal</option><option value="Kosher">Kosher</option> </select> </div> <div id="frm_field_19_container" class="frm_form_field form-field frm_required_field frm_top_container vertical_radio"> <div id="field_8pqky_label" class="frm_primary_label">I consent to sharing my email address with the congress organisers for communication about upcoming events. You can unsubscribe or email info@londocor.co.za at any time to opt out. <span class="frm_required" aria-hidden="true">*</span> </div> <div class="frm_opt_container" aria-labelledby="field_8pqky_label" role="group"> <div class="frm_checkbox" id="frm_checkbox_19-7-0"><label for="field_8pqky-0"><input type="checkbox" name="item_meta[19][]" id="field_8pqky-0" value="Yes" data-sectionid="7" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="I consent to sharing my email address with the congress organisers for communication about upcoming events. You can unsubscribe or email info@londocor.co.za at any time to opt out. is invalid" aria-invalid="false" /> Yes</label></div> <div class="frm_checkbox" id="frm_checkbox_19-7-1"><label for="field_8pqky-1"><input type="checkbox" name="item_meta[19][]" id="field_8pqky-1" value="No" data-sectionid="7" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="I consent to sharing my email address with the congress organisers for communication about upcoming events. You can unsubscribe or email info@londocor.co.za at any time to opt out. is invalid" aria-invalid="false" /> No</label></div> </div> </div> </div> <div id="frm_field_21_container" class="frm_form_field frm_section_heading form-field "> <h3 class="frm_pos_top frm_section_spacing">Pre-Congress Workshops: 4 September 2025</h3> <div id="frm_field_22_container" class="frm_form_field form-field frm_top_container vertical_radio"> <div id="field_yunf1_label" class="frm_primary_label">Parallel Workshops (08:00 - 11:30) <span class="frm_required" aria-hidden="true"></span> </div> <div class="frm_opt_container" aria-labelledby="field_yunf1_label" role="group"> <div class="frm_checkbox" id="frm_checkbox_22-21-0"><label for="field_yunf1-0"><input type="checkbox" name="item_meta[22][]" id="field_yunf1-0" value="Workshop One 825" data-sectionid="21" data-frmlimit="1" data-invmsg="Parallel Workshops (08:00 - 11:30) is invalid" aria-invalid="false" /> Workshop 1: Point-of-care ultrasound services - <strong>R825</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_22-21-1"><label for="field_yunf1-1"><input type="checkbox" name="item_meta[22][]" id="field_yunf1-1" value="Workshop Two 825" data-sectionid="21" data-frmlimit="1" data-invmsg="Parallel Workshops (08:00 - 11:30) is invalid" aria-invalid="false" /> Workshop 2: Ventilation strategies: invasive and non-invasive - <strong>R825</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_22-21-2"><label for="field_yunf1-2"><input type="checkbox" name="item_meta[22][]" id="field_yunf1-2" value="Workshop Three 825" data-sectionid="21" data-frmlimit="1" data-invmsg="Parallel Workshops (08:00 - 11:30) is invalid" aria-invalid="false" /> Workshop 3: aEEG and EEG indications, interpretation and monitoring - <strong>R825</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_22-21-3"><label for="field_yunf1-3"><input type="checkbox" name="item_meta[22][]" id="field_yunf1-3" value="Workshop Four 825" data-sectionid="21" data-frmlimit="1" data-invmsg="Parallel Workshops (08:00 - 11:30) is invalid" aria-invalid="false" /> Workshop 4: AKI Dialysis for Beginners - <strong>R825</strong></label></div> </div> </div> </div> <div id="frm_field_25_container" class="frm_form_field frm_section_heading form-field "> <h3 class="frm_pos_top frm_section_spacing">Full Registration: 5-7 September 2025 (Excluding Workshops)</h3> <div id="frm_field_26_container" class="frm_form_field form-field frm_top_container vertical_radio"> <div id="field_1x8m1_label" class="frm_primary_label">Full Congress Registration <span class="frm_required" aria-hidden="true"></span> </div> <div class="frm_opt_container" aria-labelledby="field_1x8m1_label" role="group"> <div class="frm_checkbox" id="frm_checkbox_26-25-0"><label for="field_1x8m1-0"><input type="checkbox" name="item_meta[26][]" id="field_1x8m1-0" value="Specialist 5500" data-sectionid="25" data-frmlimit="1" data-invmsg="Full Congress Registration is invalid" aria-invalid="false" /> Specialists and SAPA Members - <strong>R5500</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_26-25-1"><label for="field_1x8m1-1"><input type="checkbox" name="item_meta[26][]" id="field_1x8m1-1" value="GP 4620" data-sectionid="25" data-frmlimit="1" data-invmsg="Full Congress Registration is invalid" aria-invalid="false" /> General Practitioners - <strong>R4620</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_26-25-3"><label for="field_1x8m1-3"><input type="checkbox" name="item_meta[26][]" id="field_1x8m1-3" value="Registrars 4500" data-sectionid="25" data-frmlimit="1" data-invmsg="Full Congress Registration is invalid" aria-invalid="false" /> Registrars - <strong>R4500</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_26-25-4"><label for="field_1x8m1-4"><input type="checkbox" name="item_meta[26][]" id="field_1x8m1-4" value="Allied 3080" data-sectionid="25" data-frmlimit="1" data-invmsg="Full Congress Registration is invalid" aria-invalid="false" /> Allied Health Professionals and Nurses - <strong>R3080</strong></label></div> </div> </div> </div> <div id="frm_field_28_container" class="frm_form_field frm_section_heading form-field "> <h3 class="frm_pos_top frm_section_spacing">Day Registration (Excluding Workshops)</h3> <div id="frm_field_29_container" class="frm_form_field form-field frm_top_container vertical_radio"> <div id="field_3pykc_label" class="frm_primary_label">Friday 5 September 2025 <span class="frm_required" aria-hidden="true"></span> </div> <div class="frm_opt_container" aria-labelledby="field_3pykc_label" role="group"> <div class="frm_checkbox" id="frm_checkbox_29-28-0"><label for="field_3pykc-0"><input type="checkbox" name="item_meta[29][]" id="field_3pykc-0" value="Specialist 2070" data-sectionid="28" data-frmlimit="1" data-invmsg="Friday 5 September 2025 is invalid" aria-invalid="false" /> Specialists and SAPA Members - <strong>R2070</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_29-28-1"><label for="field_3pykc-1"><input type="checkbox" name="item_meta[29][]" id="field_3pykc-1" value="GP 1800" data-sectionid="28" data-frmlimit="1" data-invmsg="Friday 5 September 2025 is invalid" aria-invalid="false" /> General Practitioners - <strong>R1800</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_29-28-2"><label for="field_3pykc-2"><input type="checkbox" name="item_meta[29][]" id="field_3pykc-2" value="Registrar 1740" data-sectionid="28" data-frmlimit="1" data-invmsg="Friday 5 September 2025 is invalid" aria-invalid="false" /> Registrars - <strong>R1740</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_29-28-3"><label for="field_3pykc-3"><input type="checkbox" name="item_meta[29][]" id="field_3pykc-3" value="Allied 1340" data-sectionid="28" data-frmlimit="1" data-invmsg="Friday 5 September 2025 is invalid" aria-invalid="false" /> Allied Health Professionals and Nurses - <strong>R1340</strong></label></div> </div> </div> <div id="frm_field_30_container" class="frm_form_field form-field frm_top_container vertical_radio"> <div id="field_1g77q_label" class="frm_primary_label">Saturday 6 September <span class="frm_required" aria-hidden="true"></span> </div> <div class="frm_opt_container" aria-labelledby="field_1g77q_label" role="group"> <div class="frm_checkbox" id="frm_checkbox_30-28-0"><label for="field_1g77q-0"><input type="checkbox" name="item_meta[30][]" id="field_1g77q-0" value="Specialist 2070" data-sectionid="28" data-frmlimit="1" data-invmsg="Saturday 6 September is invalid" aria-invalid="false" /> Specialists and SAPA Members - <strong>R2070</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_30-28-1"><label for="field_1g77q-1"><input type="checkbox" name="item_meta[30][]" id="field_1g77q-1" value="GP 1800" data-sectionid="28" data-frmlimit="1" data-invmsg="Saturday 6 September is invalid" aria-invalid="false" /> General Practitioners - <strong>R1800</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_30-28-2"><label for="field_1g77q-2"><input type="checkbox" name="item_meta[30][]" id="field_1g77q-2" value="Registrar 1740" data-sectionid="28" data-frmlimit="1" data-invmsg="Saturday 6 September is invalid" aria-invalid="false" /> Registrars - <strong>R1740</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_30-28-3"><label for="field_1g77q-3"><input type="checkbox" name="item_meta[30][]" id="field_1g77q-3" value="Allied 1340" data-sectionid="28" data-frmlimit="1" data-invmsg="Saturday 6 September is invalid" aria-invalid="false" /> Allied Health Professionals and Nurses - <strong>R1340</strong></label></div> </div> </div> <div id="frm_field_31_container" class="frm_form_field form-field frm_top_container vertical_radio"> <div id="field_qg331_label" class="frm_primary_label">Sunday 7 September <span class="frm_required" aria-hidden="true"></span> </div> <div class="frm_opt_container" aria-labelledby="field_qg331_label" role="group"> <div class="frm_checkbox" id="frm_checkbox_31-28-0"><label for="field_qg331-0"><input type="checkbox" name="item_meta[31][]" id="field_qg331-0" value="Specialist 2070" data-sectionid="28" data-frmlimit="1" data-invmsg="Sunday 7 September is invalid" aria-invalid="false" /> Specialists and SAPA Members - <strong>R2070</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_31-28-1"><label for="field_qg331-1"><input type="checkbox" name="item_meta[31][]" id="field_qg331-1" value="GP 1800" data-sectionid="28" data-frmlimit="1" data-invmsg="Sunday 7 September is invalid" aria-invalid="false" /> General Practitioners - <strong>R1800</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_31-28-2"><label for="field_qg331-2"><input type="checkbox" name="item_meta[31][]" id="field_qg331-2" value="Registrar 1740" data-sectionid="28" data-frmlimit="1" data-invmsg="Sunday 7 September is invalid" aria-invalid="false" /> Registrars - <strong>R1740</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_31-28-3"><label for="field_qg331-3"><input type="checkbox" name="item_meta[31][]" id="field_qg331-3" value="Allied 1340" data-sectionid="28" data-frmlimit="1" data-invmsg="Sunday 7 September is invalid" aria-invalid="false" /> Allied Health Professionals and Nurses - <strong>R1340</strong></label></div> </div> </div> </div> <div id="frm_field_34_container" class="frm_form_field frm_section_heading form-field "> <h3 class="frm_pos_top frm_section_spacing">Social Function</h3> <div id="frm_field_35_container" class="frm_form_field form-field frm_required_field frm_top_container vertical_radio"> <div id="field_rk60s_label" class="frm_primary_label">Umcimbi Dinner Gathering - Saturday 6 September 2025 <span class="frm_required" aria-hidden="true">*</span> </div> <div class="frm_opt_container" aria-labelledby="field_rk60s_label" role="group"> <div class="frm_checkbox" id="frm_checkbox_35-34-0"><label for="field_rk60s-0"><input type="checkbox" name="item_meta[35][]" id="field_rk60s-0" value="Attending 500" data-sectionid="34" data-frmlimit="1" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Umcimbi Dinner Gathering - Saturday 6 September 2025 is invalid" aria-invalid="false" /> Attending - <strong>R500</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_35-34-1"><label for="field_rk60s-1"><input type="checkbox" name="item_meta[35][]" id="field_rk60s-1" value="Not" data-sectionid="34" data-frmlimit="1" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Umcimbi Dinner Gathering - Saturday 6 September 2025 is invalid" aria-invalid="false" /> Not Attending</label></div> </div> </div> <div id="frm_field_39_container" class="frm_form_field form-field frm_required_field frm_top_container vertical_radio"> <div id="field_vmnrp_label" class="frm_primary_label">Partner Attending Umcimbi Dinner Gathering <span class="frm_required" aria-hidden="true">*</span> </div> <div class="frm_opt_container" aria-labelledby="field_vmnrp_label" role="group"> <div class="frm_checkbox" id="frm_checkbox_39-34-0"><label for="field_vmnrp-0"><input type="checkbox" name="item_meta[39][]" id="field_vmnrp-0" value="Attending 500" data-sectionid="34" data-frmlimit="1" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Partner Attending Umcimbi Dinner Gathering is invalid" aria-invalid="false" /> Attending - <strong>R500</strong></label></div> <div class="frm_checkbox" id="frm_checkbox_39-34-2"><label for="field_vmnrp-2"><input type="checkbox" name="item_meta[39][]" id="field_vmnrp-2" value="Not" data-sectionid="34" data-frmlimit="1" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Partner Attending Umcimbi Dinner Gathering is invalid" aria-invalid="false" /> Not Attending</label></div> </div> </div> <div id="frm_field_40_container" class="frm_form_field form-field frm_required_field frm_top_container frm6 frm_first"> <label for="field_cts0h" id="field_cts0h_label" class="frm_primary_label">Partner Name and Surname <span class="frm_required" aria-hidden="true">*</span> </label> <input type="text" id="field_cts0h" name="item_meta[40]" value="" data-sectionid="34" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Text is invalid" aria-invalid="false" /> </div> <div id="frm_field_41_container" class="frm_form_field form-field frm_required_field frm_top_container frm6"> <label for="field_7bebv" id="field_7bebv_label" class="frm_primary_label">Partner Dietary Requirement <span class="frm_required" aria-hidden="true">*</span> </label> <select name="item_meta[41]" id="field_7bebv" data-sectionid="34" data-frmval="None" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Partner Dietary Requirement is invalid" aria-invalid="false" > <option value="None" selected='selected'>None</option><option value="Vegetarian">Vegetarian</option><option value="Vegan">Vegan</option><option value="Halaal">Halaal</option><option value="Kosher">Kosher</option> </select> </div> </div> <div id="frm_field_44_container" class="frm_form_field frm_section_heading form-field "> <h3 class="frm_pos_top frm_section_spacing">Registration Fee Summary</h3> <div id="frm_field_45_container" class="frm_form_field form-field frm_top_container frm6 frm_first"> <label for="field_8i7l5" id="field_8i7l5_label" class="frm_primary_label">Pre-Congress Workshop Fees <span class="frm_required" aria-hidden="true"></span> </label> <input type="text" id="field_8i7l5" name="item_meta[45]" value="" readonly="readonly" data-sectionid="44" data-invmsg="Text is invalid" aria-invalid="false" /> </div> <div id="frm_field_46_container" class="frm_form_field form-field frm_top_container frm6"> <label for="field_zk0qw" id="field_zk0qw_label" class="frm_primary_label">Full Registration Fees <span class="frm_required" aria-hidden="true"></span> </label> <input type="text" id="field_zk0qw" name="item_meta[46]" value="" readonly="readonly" data-sectionid="44" data-invmsg="Text is invalid" aria-invalid="false" /> </div> <div id="frm_field_47_container" class="frm_form_field form-field frm_top_container frm6 frm_first"> <label for="field_8di7z" id="field_8di7z_label" class="frm_primary_label">Day Registration Fees <span class="frm_required" aria-hidden="true"></span> </label> <input type="text" id="field_8di7z" name="item_meta[47]" value="" readonly="readonly" data-sectionid="44" data-invmsg="Text is invalid" aria-invalid="false" /> </div> <div id="frm_field_48_container" class="frm_form_field form-field frm_top_container frm6"> <label for="field_wvo9q" id="field_wvo9q_label" class="frm_primary_label">Social Function Fees <span class="frm_required" aria-hidden="true"></span> </label> <input type="text" id="field_wvo9q" name="item_meta[48]" value="" readonly="readonly" data-sectionid="44" data-invmsg="Text is invalid" aria-invalid="false" /> </div> <div id="frm_field_49_container" class="frm_form_field form-field frm_top_container"> <label for="field_ezvp6" id="field_ezvp6_label" class="frm_primary_label"><strong>Total Registration Fees</strong> <span class="frm_required" aria-hidden="true"></span> </label> <input type="text" id="field_ezvp6" name="item_meta[49]" value="" readonly="readonly" data-sectionid="44" data-invmsg="Text is invalid" aria-invalid="false" /> </div> <div id="frm_field_50_container" class="frm_form_field form-field frm_required_field frm_top_container vertical_radio"> <div id="field_mi4to_label" class="frm_primary_label">Payment Method <span class="frm_required" aria-hidden="true">*</span> </div> <div class="frm_opt_container" aria-labelledby="field_mi4to_label" role="group"> <div class="frm_checkbox" id="frm_checkbox_50-44-1"><label for="field_mi4to-1"><input type="checkbox" name="item_meta[50][]" id="field_mi4to-1" value="Electronic Transfer (EFT)" checked="checked" data-sectionid="44" data-frmval="{"1":"Electronic Transfer (EFT)"}" data-reqmsg="This field cannot be blank." aria-required="true" data-invmsg="Payment Method is invalid" aria-invalid="false" /> Electronic Transfer (EFT)</label></div> </div> </div> <div id="frm_field_109_container" class="frm_form_field frm_html_container form-field">Please use your <strong>surname </strong>when submitting payment. The banking details will be supplied once you have submitted your registration. Notice of cancellation must be given in writing to carina@londocor.co.za. Cancellations received by 24 July 2025, will incur a 50% cancellation fee. Cancellations received from 25 July 2025, will incur a 100% cancellation fee.</div> </div> <input type="hidden" name="item_meta[53]" id="field_b553n" value="" data-invmsg="Total Paid is invalid" /> <input type="hidden" name="item_meta[54]" id="field_lgm2p" value="" data-invmsg="Unpaid is invalid" /> <input type="hidden" name="item_meta[55]" id="field_8l2eu" value="" data-invmsg="Payment Date is invalid" /> <input type="hidden" name="item_key" value="" /> <div class="frm_verify" aria-hidden="true"> <label for="frm_email_2"> If you are human, leave this field blank. </label> <input type="text" class="frm_verify" id="frm_email_2" name="frm_verify" value="" /> </div> <input name="frm_state" type="hidden" value="/VxBc6fbPj8NMvhhve83UKjxncTkyfdGbfbsyiZra9o=" /><div class="frm_submit"> <button class="frm_button_submit frm_final_submit" type="submit" formnovalidate="formnovalidate">Register</button> </div></div> </fieldset> </div> </form> </div> </div> </div> </div> </div> </div> </div> </main> <div data-elementor-type="footer" data-elementor-id="18" class="elementor elementor-18 elementor-location-footer" data-elementor-post-type="elementor_library"> <div class="elementor-element elementor-element-c4a9828 e-flex e-con-boxed e-con e-parent" data-id="c4a9828" data-element_type="container" data-settings="{"ekit_has_onepagescroll_dot":"yes"}"> <div class="e-con-inner"> <div class="elementor-element elementor-element-e206b1f elementor-widget-divider--view-line elementor-widget elementor-widget-divider" data-id="e206b1f" data-element_type="widget" data-settings="{"ekit_we_effect_on":"none"}" data-widget_type="divider.default"> <div class="elementor-widget-container"> <div class="elementor-divider"> <span class="elementor-divider-separator"> </span> </div> </div> </div> </div> </div> <div class="elementor-element elementor-element-e2713e2 e-flex e-con-boxed e-con e-parent" data-id="e2713e2" data-element_type="container" data-settings="{"ekit_has_onepagescroll_dot":"yes"}"> <div class="e-con-inner"> <div class="elementor-element elementor-element-3145c93 e-con-full e-flex e-con e-child" data-id="3145c93" data-element_type="container" data-settings="{"ekit_has_onepagescroll_dot":"yes"}"> <div class="elementor-element elementor-element-6ee900c elementor-widget elementor-widget-image" data-id="6ee900c" data-element_type="widget" data-settings="{"ekit_we_effect_on":"none"}" data-widget_type="image.default"> <div class="elementor-widget-container"> <img width="300" height="70" src="https://sapa2025.co.za/wp-content/uploads/2024/08/SAPA-2025-Footer-Logos-Nelson-Mandela.jpg" class="attachment-full size-full wp-image-775" alt="" /> </div> </div> </div> <div class="elementor-element elementor-element-b0d410c e-con-full e-flex e-con e-child" data-id="b0d410c" data-element_type="container" data-settings="{"ekit_has_onepagescroll_dot":"yes"}"> <div class="elementor-element elementor-element-b356d79 elementor-widget elementor-widget-image" data-id="b356d79" data-element_type="widget" data-settings="{"ekit_we_effect_on":"none"}" data-widget_type="image.default"> <div class="elementor-widget-container"> <img width="300" height="70" src="https://sapa2025.co.za/wp-content/uploads/2024/08/SAPA-2025-Footer-Logos-Walter-Sisulu.jpg" class="attachment-full size-full wp-image-776" alt="" /> </div> </div> </div> </div> </div> <div class="elementor-element elementor-element-7e9217d e-flex e-con-boxed e-con e-parent" data-id="7e9217d" data-element_type="container" data-settings="{"background_background":"classic","ekit_has_onepagescroll_dot":"yes"}"> <div class="e-con-inner"> <div class="elementor-element elementor-element-5151c40 elementor-widget elementor-widget-text-editor" data-id="5151c40" data-element_type="widget" data-settings="{"ekit_we_effect_on":"none"}" data-widget_type="text-editor.default"> <div class="elementor-widget-container"> Managed by 漏 <a style="color: #ffffff;" href="https://londocor.co.za/">Londocor Event Management</a>. 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