::: onq conferences - Fenner Conference on the Environment :::

Registration Form
Fenner Conference on the Environment
'incorporating AWMS Conference 2007'
Sunday, December 02 - Wednesday, December 05 2007
Shine Dome, Australian Academy of Science

Instructions:
1. Please complete all sections fully.
2. A separate form must be used for each delegate.
3. Where appears, indicate preference by selecting one option.
4. By submitting your registration you agree to the terms and conditions of the accommodation and registration cancellation policies as outlined in the registration brochure.

On Q Conference Support
Email: info@onqconferences.com.au
Tel: 02 6161 9024
Fax: 02 6161 4719

This is a secure registration form that will be forwarded to On Q Conference Support. Please note that this form is being processed via our secure ssl server and none of the information submitted on this form is stored online.

Section 1: Personal Details

Title:

First name:

Surname:

Gender:

M F

Position:

Organisation:

Address:

Work Home

Street:

City:

State:

Postcode:

Country:

Telephone:

work

home/mobile

Fax:

Email:

Preferred name for lapel badge (first and surname):

Membership status:

Member:
AWMS Member
Membership ID number:
Non-member

I do not wish to have my personal details made available on the delegate list

Section 2: Special Requirements

Dietary:

Mobility:

Section 3: Registration Fees (all fees include 10% GST)

MEMBER

NON-MEMBER

Earlybird rate: ( before Tuesday, October 16 2007)

AUD$490.00

AUD$560.00

Standard rate: (from Wednesday, October 17 2007

AUD$560.00

AUD$630.00

Student rate:

AUD$300.00

AUD$350.00

Day only rate:
(does not include social events)

AUD$230.00 per day
Please indicate which day(s) you will be attending:
Day 1: Sunday 02/12/07
Day 2: Monday 03/12/07
Day 3: Tuesday 04/12/07
Day 4: Wednesday 05/12/07

AUD$0.00 per day

Full registration includes catering and attendance at the conference dinner. Early Bird registration must be received by the conference secretariat on or before 16 October 2007. IF YOU DO NOT KNOW YOUR MEMBERSHIP NUMBER, PLEASE ENTER "DO NOT KNOW" IN THIS AREA.

Section 4: Social Program

If you wish to attend any of the functions, please complete this section. This information is essential for catering purposes and tickets will NOT be issued unless a booking has been made.

Icebreaker BBQ - Sunday 2nd December 2007, Sunday December 2
Yes, I wish to attend the Icebreaker BBQ - Sunday 2nd December 2007 @ AUD$35.00 (incl. GST)	Total AUD$
Yes, I wish to bring guests @ AUD$35.00 (incl. GST)	Total AUD$

Conference Dinner at Botanical Gardens, Tuesday December 4
Yes, I wish to attend the Conference Dinner at Botanical Gardens (cost is included in the standard and earlybird registration fees)
Yes, I wish to bring guests @ AUD$85.00 (incl. GST)	Total AUD$

One ticket to the Conference dinner is included in full registrations only on the basis that you indicate if you will be attending the functions by ticking the appropriate box below. If you do not indicate attendance, no ticket will be issued for you. Day registrants and guests must pay to attend.

Section 5: Accommodation

Accommodation is available at special conference rates at the following hotel venues. Please indicate your preference/s (1-2) by indicating on the lines provided. Rates are GST inclusive and are per room, per night, unless otherwise specified.

			Preference:

Rydges Lakeside Canberra
London Circuit - five minute walk	Standard (Single/Double)	AUD$179.00
	Twin	AUD$179.00

Liversidge Court (ANU)
Liversidge St, ANU Campus	Studio Apartment	AUD$116.00
	Single/Double	AUD$125.00

John XXIII College (student accommmodation)
ANU Campus, shared facilities includes all meals	Single	AUD$70.00

Single	Double	Twin
Non-smoking	Smoking

Date in:

Day: Month: Year:

Date out:

Day: Month: Year:

Estimated time of arrival:

I will be accompanied by or have arranged to share with:

PAYMENT DETAILS

Credit Card details OR a one night deposit is required as a guarantee to secure and confirm your accommodation booking. Credit card information is passed onto the venue and it is at their discretion whether you will be charged for a deposit prior to arrival. Cancellations may incur a penalty. Full address details of properties will be sent to you with confirmation of the booking.

Please prepay nights accommodation, $AUD by cheque , direct deposit or credit card.

Please forward my credit card details to the hotel

Section 6: Payment Details

PAYMENT SUMMARY:

TAX INVOICE
ABN: 93 835 779 670

Registration Fees:

AUD$

Social Program:

AUD$

Accommodation:

AUD$

Total:

AUD$

Payment can be made by:

Cheque (made payable to make payable to On Q Conference Support)

Credit Card OR

Number on card:

Name of cardholder:

Expiry date:

Direct Deposit (EFT)

To BSB: 062 912 Account No: 1015 3163 Account Name: On Q Conference Support
Please note the date of your direct deposit:
Reference Code:

Amount Enclosed:

AUD$

NOTE: In registering for this event relevant details may be incorporated into a delegate list for the benefit of all delegates (name, position and organisation only) and may be made available to parties directly related to the event.