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

Personal Details
-
Title
-First Name -Surname
Position
Organisation
Address

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

Name for Badge


Organisation and State as provided above will also be included on your badge

Special Requirements eg Diet-
 
Privacy Disclosure

I DO consent to my name appearing in the Conference List of Participants (name, organisation and state only disclosed).

 
Abstract Submission

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.

I have submitted an abstract and I am the contact person
My abstract code as quoted in my confirmation letter is
(to be quoted by the contact person ONLY not co-presenters)
-
Registration Fees
  Member registration fees    
  Early (payment received before 22 June 2012) $625  
  Late (payment received after 22 June 2012) $725  
       
  Non-Member registration fees    
  Early (payment received before 22 June 2012) $725  
  Late (payment received after 22 June 2012) $825  
       
  Member Day registration fees (per day)    
  Early (payment received before 22 June 2012) $300  
  Late (payment received after 22 June 2012) $350  
       
  Non-Member Day registration fees (per day)    
  Early (payment received before 22 June 2012) $340  
  Late (payment received after 22 June 2012) $390  
       
  Day delegates indicate which day you will attend Saturday

  Total
 
Social Functions

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.

Welcome Reception, Thursday 26 July 2012

I WILL ATTEND - Delegate-Number of Additional Tickets @ $55.00 each-Total -(only required for additional tickets and day delegates)

Conference Dinner, Friday 27 July 2012
I WILL ATTEND - Delegate-Number of Additional Tickets @ $110.00 each-Total -(only required for additional tickets and day delegates)
GRAND TOTAL -
Registration and Social Function Payment
I am forwarding a cheque made payable to Women and Firefighting Australasia Incorporated   
Please issue an invoice (Invoices are automatically issued on receipt of registrations)
I am processing an EFT payment, My receipt number is
351312
 
Accounts Contact
Title -First Name -Surname

Accounts Email-

 
IF YOU DO NOT REQUIRE ACCOMMODATION
PROCEED TO THE SUBMIT BUTTON AT THE BOTTOM OF THE PAGE
 
Accommodation

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 13 July 2012.  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.

   
-
   
Hotel Grand Chancellor on Hindley
 
 
-
 

Date of Arrival-- (dd/mm/yy)-Date of Departure (dd/mm/yy)

Estimated Time of Arrival- -Sharing with (if applicable)

Special Requirements-

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 Details

Card Number -   

Card Signatories Name - Expiry
 
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.