Seeing Things Differently - Conference On The Net

RECEIVED:
REG. No.
ATBH5 Registration Form
ALL FIGURES ARE IN AUSTRALIAN DOLLARS AND INCLUDE GST.
CONFERENCE ACTION ABN 35 002 729 606
Please complete and return to: ATBH5 Conference Secretariat
Conference Action Pty Ltd, PO Box 57, CROWS NEST NSW 1585 AUSTRALIA
Tel: +61 2 9431 8699 Fax: +61 2 9431 8677 Email: ATBH5@conferenceaction.com.au
Section A: Delegate
Title: Given Name: Surname:
Position:
Organisation:
Organisation Address:
Suburb: State: Country: Postcode:
Tel: ( ) Fax: ( )
Email:
(required for your emailed confirmation details)
Dietary Requirements:
(this is not dietary preferences but actual requirements such as vegetarian, vegan, lactose intolerant, etc)
Section B: Registration Fees
By 19 FEB 2010 AFTER 19 FEB 2010 PayMENT
InterEd Member A$850.00 A$950.00 $
Non-Member A$950.00 A$1,050.00 $
Student A$550.00 A$550.00 $
One Day A$330.00 A$380.00 $
Please tick day of attendance for one day delegates Tues, 6 April Wed, 7 April Thur, 8 April Fri, 9 April
TOTAL REGISTRATION FEES $
Section C: Accommodation
Date of arrival: _______ / April / 2010 Date of departure: _______ / April / 2010
Room type: Please tick (3) Single Smoking room
Double Non-smoking room
Twin Sharing with:
Frequent flyer card details:
Qantas
Velocity
Other:
Membership No:
continued overleaf
16 Register online at www.atbh5.com.au