Registration

Cash Payments to Mr Nyamayaro at Diamond Pharmacy, Jason Moyo & Angwa Street.

NB: Please complete the form below, only after you have made your payments

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Proffession Method Proof

Title

Full Name

Gender

Phone

Proffession

Organisation/Company Name

Membership / Attendance Status

Method of Payment

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Passport Sized Photo / Selfie

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Cocktail 7pm-9pm?

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NB: Please note that there will be no refunds. Terms and Conditions Apply