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2017 Roads Congress, Albany Entertainment Centre
Registration Form


By submitting this form you agree to the terms of the cancellation policy set out in the conference information brochure.
All prices quoted are in Australian Dollars and are inclusive of GST.   ALGA ABN: 31 008 613 876

The data in this form is not recorded until the SUBMIT button is pushed. The SUBMIT button is at the bottom of this form. 

NOTE: You will receive a confirmation via email of your registration (which will also be your tax invoice) within seven days from Conference Co-ordinators. 
If you do not receive written confirmation please contact Conference Co-ordinators on +61 (0)2 6292 9000 or via email at roadscongress@confco.com.au.


This form is for NEW REGISTRATIONS ONLY.  To make an AMENDMENT contact Conference Co-ordinators
Personal Details
  Please DO NOT type in ALL CAPITALS
Title   First Name  Surname
Position 
Council/Organisation 
Address
Suburb   State   Postcode
Phone   Fax  Mobile
Delegates Email This email will be used to send your confirmation letter to you and any event updates
Reconfirm Email Re-enter your email address here to ensure it is correct
Name for Badge Organisation and State as provided above will also be included on your badge
Type of Council
SPECIAL REQUIREMENTS: Inclduing Dietary (eg Vegetarian) AND Additional Information required (eg Mobility)
 
Privacy Disclosure
I consent to my name appearing in the 2017 List of Participants (name, organisation and state only disclosed).
 
Registration Fees
The 2017 Convention will take place at the Albany Entertainment Centre
DELEGATE REGISTRATION FEES  
EARLY Registration Fee (payment received before 29 September 2017) $890
LATE Registration Fee (payment received after 29 September 2017) $990
   

ALBANY SHOWCASE TOUR

Departing from Albany Entertainment Centre at 11.00am

 
Not Required Not Required
Discounted Rate for Registered Delegates $75
Rate for Guests only attending demonstration $100
  Total
Accompanying Partners
 
ACCOMPANYING PARTNER REGISTRATION FEES  
Tuesday 7 November: Tour 1 Not Required $70
Wednesday 8 November: Tour 2 Not Required $70
 
Accompanying Partners Details
 First Name  Surname
Partners Special Requirements eg diet
 
Social Functions Included in Fees
One ticket to each of the following functions is included in the full Roads Congress Registration fee. Please confirm if you will be attending by selecting the appropriate boxes.

 

To purchase additional tickets to any of the functions please indicate the number required.

Welcome Reception, Monday 6 November
I will attend  Delegate    Number of Additional Tickets @ $50.00 each Total
Congress Dinner: Tuesday 7 November 
I will attend  Delegate    Number of Additional Tickets @ $95.00 each Total
   
  GRAND TOTAL
 
Perth - Albany Airport Bus Transfers
 

Please click if you would like to receive information on transfers when available.

 
Registration and Social Function Payment Details
I am forwarding a cheque made payable to the ALGA Roads Congress
Please issue an invoice (Invoices are automatically issued on receipt of registrations)
I have transacted an Electronic Funds Transfer to the ALGA Roads Congress.

ALGA Account: Bank: Commonwealth Branch: Curtin BSB No: 062 905 Account No: 1014 6120. NOTE This account is specifically for conference payments ONLY

Please charge my credit card the total noted above MasterCard VISA
Card Number      Expiry Date
Name of the person who signs the card
NOTE: Credit cards are not automatically charged when you submit this form. Cards are processed within 5 working days of submission.
Accounts/Billing Contact
If your require a copy of the invoice to be sent to an email address that is different to the one completed under delegate information please complete it below. 
NOTE: A copy of the invoice/confirmation will also be sent to the email address provided under delegate information.
  First Name  Surname
  Email
 
Accommodation
If you DO NOT require accommodation proceed to the SUBMIT button at the bottom of the page
To book your accommodation at the rates listed below complete this section of the registration form. Bookings are subject to availability and should be made prior to 14 October 2016. All cancellations or amendments must be made in writing to Conference Co-ordinators and will be acknowledged by facsimile. Please note your credit card details are required to guarantee your room. Neither Conference Co-ordinators nor the hotel will make any charges against your credit card unless you fail to give 21 days notice in writing of your cancellation. Full payment of your account will be required at the time of your departure.
 

Please note: Additional accommodation options will be added to the booking form below once confirmed.

 

Rates quoted below are per room per night    
Dog Rock Motel Hotel Information    
Deluxe Queen Room $194 per night Single Double
Deluxe Twin Room $224 per night Twin
Executive Room $228 per night  **SOLD OUT**
Executive Twin Room $258 per night Twin
Best Western Albany Motel & Apartments Hotel Information    

Classic Room

$171 per night  **SOLD OUT**
Executive Balcony Room $203 per night  **SOLD OUT**
Premier Harbour View Room $227 per night  **SOLD OUT**
Junior Two-Room Suite $253 per night Single Twin Double
Two Bedroom Family Apartment $287 per night Single Twin Double
Quality Suites Banksia Gardens Albany Hotel Information    
1 Bedroom Suite Apartment $192.50 per night Single Double
1 Bedroom Apartment $203.50 per night  **SOLD OUT**
2 Bedroom Apartment $203.50 per night Queen + Single Queen + Queen
 
Please indicate your second and third choices of accommodation below should your first choice not be available.
2nd Choice
3rd Choice
USE date format dd/mm/yyyy  you MUST use the / key
Date of Arrival (dd/mm/yyyy) Date of Departure (dd/mm/yyyy)  
Estimated Time of Arrival Sharing with (if applicable)  
Special Requirements eg Diet, Mobliity
I understand that neither Conference Co-ordinators or the hotel will make any charges against my card unless I fail to give at least 21 days notice in writing of my cancellation.  Cancellations or reductions to your booking made less than 21 days prior to your arrival will require payment in full unless the room(s) can be resold.  Full payment of the account will be required at the time of departure.
 
Accommodation Credit Card Guarantee Details
 
Please use the credit card details provided above (to pay for my registration) to guarantee my accommodation
OR Please use the following credit card to guarantee my room MasterCard VISA American Express      Expiry
Card Number    Card Signatories Name  
 
If you would like pay for the accommodation via a corporate credit card, please click here to download the credit card authorisation template. Once you have confirmation of accommodation, please email form to roadscongress@confco.com.au

A credit card is still required to guarantee the room.

 
Cancellation Policy
I understand that by submitting this registration form I agree to the terms of the cancellation policy. Click here to view the cancellation policy.
 

If your submission is successful a page will display
that thanks you for your registration and provides
further details. If the Thank-you page does not
display
contact Conference Co-ordinators
on +61 2 6292 9000 or email roadscongress@confco.com.au