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Role *SelectStore ManagerPharmacy ManagerArea ManagerRegional ManagerHead OfficeExecutiveOther Store Ops Support

Store Name *

Store Name *

Store Number *

Store Number *

Employee Number *

Title *SelectMr.Miss.Mrs.Dr.Prof.

First Name *

* As it appears in your I.D.

Surname *

* As it appears in your I.D.

Are you attending the Inland North Roadshow 2024? *

• Yes
• No

Dietary RequirementsNoneVegetarianVeganHalaalKosherOther

If other, please advise

Any food allergies that we need to be aware of ?

Is Travel Required for you to get to the Roadshow venue? (More than 100km from home)

• Yes
• No

Please select the suitable type of travel you require (Subject to Managements Approval)SelectFlights + AccommodationTransfers + AccommodationAccommodation Only

Your Nearest AirportSelectCape Town International AirportKing Shaka International Airport (Durban)OR Tambo International Airport (Johannesburg)Lanseria International Airport (Johannesburg)Bloemfontein AirportPort Elizabeth AirportEast London AirportKruger Mpumalanga AirportGeorge Airport

TransfersSelectPool Vehicle - RentalPool Vehicle - Staff VehicleRental Vehicle

Accommodation Check In Date

Accommodation Check Out Date

1st Proposed Sharing Partner Name (Accommodation)

2nd Proposed Sharing Partner Name (Accommodation)

Please select a second Proposed Sharing Partner should the first selection not be available

Contact Telephone Number *

Email Address *

Terms and Conditions *

• I agree and accept the terms and conditions

By attending the Clicks Roadshow 2024 exclusively at my own risk, I hereby: Indemnify and hold New Clicks South Africa (Pty) Ltd, all their directors, members, partners, employees, agents of or consultants to New Clicks South Africa (Pty) Ltd, its subsidaries, divisions and/or associated companies (the "Organiser"), each Event Sponsor ("Sponsors") harmless against any injuries, illness, losses or damages, however they may occur, that I may suffer as a result of any occurrence arising either directly or indirectly out of my attendance at or participating in the Event or in any activity related to the Event, including use of any products whether as the causing or suffering party, which may be suffered or incurred by me. I understand that alcohol may be available and if I consume any alcohol, I take full responsibility for my actions in doing so. I shall conduct myself in an appropriate manner whether sleeping over or driving home after. I consent to the free use of images or videos of me in any marketing of the Event, by the Organiser and/or the Sponsors in relation to the Event I agree to adhere to all Event rules and conditions.

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