DGMT Human Factor Request Form

We are happy to send you a copy of the Human Factor (Issue 2). Please could you provide us with a few important details.

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* 1. What is your name and surname?

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* 2. Name of your organisation (if you are associated with one)

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* 3. If you represent an organisation what type of organisation is it?

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* 4. Contact details

Email Address

Phone Number

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* 5. Send the copy to this address:

Street

Community or neighbourhood

City/Town (nearest)

Postal Code

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* 6. The address is in this province:

The Eastern Cape

The Free State

Gauteng

Kwa-Zulu Natal

Limpopo

The Northern Cape

The North West Province

Mpumalanga

The Western Cape

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* 7. To give us a sense of how people use the Human Factor, please can you briefly tell us why would like to have a copy and if you are going to use it for something for specific, what for?