Crescendo Indemnity Form

Indemnity Form

Crescendo Summer Institute South Africa 2016

(Please print, sign and attach this page to your application form)

Declaration of applicant

Herewith I declare that the information supplied on this application form is correct and

complete.

I, the undersigned, will not hold the organisers responsible for any losses, damage, injury

or illness that may occur during the Crescendo Summer Institute South Africa 2016.

Signature of Applicant

Date _______________________________

Person to contact in case of emergency:

Name: _____________________________

Relation: ___________________________

Contact number (mobile or other): ______________________

Any comments: _____________________

23 K ANNABAS C RESCENT, V REDEKLOOF, B RACKENFELL, 7 560 S OUTH A FRICA,

+27 ( 0)21 9 81 5 551, + 27 ( 0)82 4 11 0 325

NPC ( Pty) L td R eg. N R. 2 015/260142/07

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