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. NOTE: WAFA is not registered for GST
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 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 conference@confco.com.au.
THIS FORM IS FOR NEW REGISTRATIONS ONLY.
TO MAKE AN AMENDMENT CONTACT CONFERENCE CO-ORDINATORS
Suburb
State Postcode
Phone
Fax Mobile
Delegates Email
For your confirmation letter and event updates
Reconfirm Email
Re-enter your email address here to ensure it is correct
Organisation and State as provided above will also be included on your badge
I DO consent to my name appearing in the Conference List of Participants (name, organisation and state only disclosed).
IMPORTANT: This code is to be used by the person who submitted the abstract ONLY, not co-presenters or co-authors. If you have forgotten your abstract code contact Conference Co-ordinators on 02 6292 9000. This code will prevent duplicate registrations.
My abstract code as quoted in my confirmation letter is (to be quoted by the contact person ONLY not co-presenters)
Member registration fees Early (payment received before 4 June 2010) $625 Late (payment received after 4 June 2010) $725
Non-Member registration fees Early (payment received before 4 June 2010) $700 Late (payment received after 4 June 2010) $800
Day registration fees (per day) Early (payment received before 4 June 2010) $300 Late (payment received after 4 June 2010) $350
Please indicate which day you will attend Thursday Friday Saturday
One ticket to the following functions are included in the full 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.
I WILL ATTEND DelegateNumber of Additional Tickets 0 1 2 3 4 5 6 7 8 9 10 @ $55.00 eachTotal (only required for additional tickets and day delegates)
Accounts Email
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 Friday 16 July 2010. 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.
Date of Arrival (dd/mm/yy)Date of Departure (dd/mm/yy)
Estimated Time of Arrival Sharing with (if applicable)
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.
Card Number
I understand that by submitting this registration form I agree to the terms of the cancellation policy.
Click here to view the cancellation policy.
