prevention

SOCIAL FUNCTIONS Number of Tickets Cost per Ticket Total
Additional Ticket – Welcome Function $85 $
Note: this is included with all Full Registrations
Additional Ticket – Gala Dinner $150 $
Note: this is included with all Full Registrations
Additional Ticket – Farewell Function $50 $
Note: this is included with all Full Registrations
Sub-Total Social Functions: $
TECHNICAL PROCEEDINGS Number of Items Cost per Item Total
CD-ROM Proceedings $90 $
Note: this is included with all Full Registrations
PARTNER PROGRAMME Number of Tickets Cost per Ticket Total
Monday: Tour of Mornington Peninsula
Tuesday: Tour of the Queen Victoria Markets
Wednesday: Melbourne Laneway Tour and Yarra River Cruise
ALSO INCLUDES TICKETS TO WELCOME FUNCTION, EXHIBITION OPENING,
GALA DINNER AND FAREWELL FUNCTION $420
Partners Name
Dietary/Special Requirements
PAYMENT DETAILS
Cheque (enclosed payable to The Australasian Corrosion Association Inc) OR
Sub-Total Partner Programme: $
Sub-Total Registration Fees: $
Sub-Total Social Functions: $
Sub-Total Technical Proceedings: $
Sub-Total Partner Programme: $
TOTAL AMOUNT TO PAY $
Electronic Funds Transfer Account Name: The Australasian Corrosion Association Inc BSB: 303 111
Account Number: 124 504 0 Bank: Bank West SWIFT Code: BKWAAU6P
To allow us to identify payment, please enter your surname and delegate number as the reference and forward remittance advice to corrosion@wsm.com.au
or fax to +61 3 9645 6322.
Credit Card Payment Mastercard Visa Amex Diners Club
Credit Card Number / / / ccv no.
Expiry Date / Name on card
Signature Date / /
TAX INVOICE All prices include GST Corrosion & Prevention 2012 ABN 66 214 557 257
Once paid, this registration form is recognised by the Australian Taxation Office as a compliant Tax Invoice.
Privacy statement: In registering for this conference, your registration details will be held on a database by WALDRONSMITH Management and The Australasian Corrosion Association Inc.
Information provided on this form will be used to administer the Conference including accommodation, catering, transport, support and exhibition. Your details (name, position and organisation
only) will be incorporated into a delegate list which will be made available to all conference participants. Your contact information may also be made available to parties directly related to the
conference including sponsors. For more information on the privacy policy, please visit www.waldronsmith.com.au.
If you do not wish your details to be included in these lists, please tick here.
Please return this form to:
Corrosion & Prevention 2012
C/- Waldron Smith Management
119 Buckhurst Street
South Melbourne VIC 3205
Australia
Phone: +61 3 9645 6311
Fax: +61 3 9645 6322
Email: corrosion@wsm.com.au
Terms and Conditions: The organisers reserve the right to delete or alter items in the conference or related programmes. The information contained in this programme is true and accurate
as possible at time of printing. Payments must be made prior to the conference unless approved by the ACA. ACA assumes no liability to participants, their employees or agent for any claim,
loss, damage or expense arising from the conference. Cancellations received in writing at the WSM Office 30 days prior to the Conference commencement date will receive a refund less an
administration fee of $150 including GST. No refund will be given after this date; however, an alternative delegate name may be submitted. All cancellations and substitutions must be made in
writing to the WSM Office. Accommodation cancellations are at the discretion of the accommodation provider. For full accommodation cancellation details please refer to the conference website.