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Registration Form

By submitting this form you agree to the terms of the cancellation policy.
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 nga@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     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
SPECIAL REQUIREMENTS: Inclduing Dietary (eg Vegetarian) AND Additional Information required (eg Mobility)

 

 
How did you find out about the National General Assembly?       Please Specify
Privacy Disclosure
I consent to my name appearing in the 2017 NGA List of Participants (name, organisation and state only disclosed).
I consent to ALGA disclosing my personal contact information as outlined in the privacy disclosure.
 
Registration Fees
National General Assembly Registration Fees (Monday 19 June - Wednesday 21 June)
Total

Business Papers will be provided to you in hard copy on arrival at the NGA, they will be available electronically approximately 2 weeks prior to the event. 

Not sending a hard copy will help reduce to carbon footprint of the event however if you do require a hard copy prior to the event please advise.

  

 
Regional Development Forum Registration Fees (Sunday 18 June)
Total
Delegate Registration Fee Sub total 
 
Accompanying Partners Registration Fees
Total
 
Accompanying Partners Details
Title  First Name  Surname
Partners Special Requirements eg diet
 
State of the Regions Report  - On-line License Purchase
You may purchase either of the following licenses
Single License:  Single user access to the on-line version $240.00
Organisational License:   Access to the online version for unlimited number of users within a single council, library, educational institution,
government department or organisation$700.00
 
Total
 
Social Functions Included in Fees
One ticket to each of the following functions is included in the full National General Assembly Registration and/or accompanying partners' 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.
Registered Delegates and Partners: Welcome Reception, Sunday 18 June
I/we will attend  Delegate  Partner  Number of Additional Tickets @ $50.00 each Total
Registered Partners: Day Tour 1, Monday 19 June
    Partner Number of Additional Tickets @ $110.00 each Total
Registered Partners: Day Tour 2, Tuesday 20 June
     Partner Number of Additional Tickets @ $110.00 each Total
 
Optional Social Functions (additional fee applies)
Tickets to these functions are not included in the National General Assembly registration fee or accompanying partners' registration fee. To purchase tickets to any of the following functions please indicate the number required.
Buffet Dinner, Monday 19 June
  Number of Tickets required @ $100.00 each Total
 
NGA Dinner at Parliament House, Tuesday 20 June 
  Number of Tickets required @ $130.00 each Total
   
  GRAND TOTAL
 
Registration and Social Function Payment Details
I am forwarding a cheque made payable to ALGA
Please issue an invoice (Invoices are automatically issued on receipt of registrations)
I have transacted an Electronic Funds Transfer to the ALGA Conference Account.   Transaction reference number 
ALGA Account: Bank: Commonwealth Branch: Curtin BSB No: 062 905 Account No: 10097760.
NOTE This account is specifically for conference payments ONLY
Please charge my credit card the total noted above
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 Contact
If you would like a copy of your invoice sent directly to your accounts section please provide an email and contact name below.
 First Name   Surname
Accounts 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 5 May 2017. All cancellations or amendments must be made in writing to Conference Co-ordinators and will be acknowledged by facsimile.

 

All accommodation bookings must be accompainied by a credit card in order to secure your reservation. The credit card will be not charged unless you fail to give 21 days notice in writing of your cancellation. You are required to pay for your full accommodation account and any incidental expenses incured during your stay when checking out of the hotel.

 

If you wish for the hotel to settle the account with a credit card of which the delegate is not a signatory, you must provide written authority to the hotel to do so. Please download the credit card authority autorisation form here, and send it to conference@confco.com.au when you have registered.

 
     
Crowne Plaza Hotel Information    
Superior Room $305 per night Single Twin Double
Deluxe Room $355 per night Single Twin Double
Avenue Hotel Hotel Information    
Superior King Room $240 per night Single Twin Double
1 Bedroom Apartment $280 per night Single Twin Double
Waldorf Apartments Hotel Information    
$200 per night

**SOLD OUT**
1 Bedroom Apartment $220 per night Single Twin Double
Medina Apartment Hotel    
1 Bedroom Apartment $210 per night Single Twin Double
   2 Bedroom Apartment $260 per night Single Twin Double
Qt Canberra Hotel Information    
Standard Room $249 per night Single Twin Double
Novotel Hotel Information    
  Standard Room $270 per night Single Twin Double
  Executive Room $300 per night Single Twin Double
Mantra on Northbourne Hotel Information    
Hotel Room $227 per night Single Twin Double
  1 Bedroom Apartment $269 per night Single Twin Double
     
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
     Expiry
Card Number    Card Signatories Name  
 
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 nga@confco.com.au