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 CONFERENCE REGISTRATION
   
  > Contact Details
  > Registration
  > Accommodation
  > Payment Section
  > Submission Section

Contact Details

Submit separate form for each person attending

Title (eg. Ms, Mr, Dr, Prof):
Given Name:
Family Name:
Position:
Work Tel:
Work Fax:
Home Tel:
Home Fax:
Mobile:

Email:
Name of Institution,
Organisation or Department:
Address:
Suburb/City:

State:

      Post Code:
Alternative/
Home Address:
Comments/Notes/
Special Requirements/
Invoicing details:
If you have any specific requests please advise us:
 Dietary Requirements Attendant Care Needs Interpreter/s
Sign Language Interpreter Hearing Loop or any other

Registration

Government/Institution:

 $550 per person

Local govt/ funded arts and community organisations over $100,000:

$330 per person

Organisations under $100,000 and individuals

$120 per person

Concessions (students, unwaged)

$60 per person
       
  No. of persons: Total Registration Amount: AU$

Accommodation

ACCOMMODATION OPTION 1

All Seasons Premier Swanston
(click here for hotel information)

RATE: $AU 160.00 per night (including breakfast)

  

Check-in Date
Check-out Date
Number of Nights
Number of Rooms

Name/s of guest/s to be accommodated in each room

Special requirements (eg. Dietary ; Attendant care needs)

ACCOMMODATION OPTION 2

Victoria Hotel
(click here for hotel information)

SINGLE: $AU 95.00 per night (including breakfast)

TWIN-SHARE: $AU 120.00 per night (including breakfast)

Check-in Date
Check-out Date
Number of Nights
Number of Rooms

Name/s of guest/s to be accommodated in each room

Special requirements (eg. Dietary ; Attendant care needs)
$US
Total All Seasons Hotel Accommodation Cost		 $US
Total Victoria Hotel Accommodation Cost

BEFOFRE SUBMITTING THIS FORM PLEASE ENSURE THAT YOU HAVE PROVIDED YOUR NAME & CONTACT DETAILS ABOVE

Payment Section

Calculate Registration, Dinner and Accommodation amounts (as applicable) and enter total below in payment section.

SELECT CHEQUE OR CREDIT CARD METHOD OF PAYMENT BELOW

             
 

    PAY BY CHEQUE

     In the amount of: $AU

     made payable to:
     'Common Ground Conferences'

POST TO:
Common Ground Conferences
PO Box K481 Haymarket NSW
AUSTRALIA 2000

     Conference managed by
Common Ground Conferences

   

    PAY BY CREDIT CARD

I authorise the amount of: $AU
to be processed against my credit card

Card Type: (nominate card below )

Mastercard   Bankcard  Visa   Amex 

Cardholder's Name
Credit Card Number
Expiry Date (MM/YY)
Current Date (DD/MM/YY)

Signature: ______________________ (If submitting printed form) 

 
           
 
Australian Federal Goods and Services Tax:
GST inclusive
   

Please note that submitting this form does not result in an automatic transfer of funds from your credit card account. The transaction is processed manually only after confirmation of your credit card authorisation has been sent to you.
 
    TO REGISTER AND PAY BY CHEQUE:     TO REGISTER AND PAY BY CREDIT CARD:  
 
  • Register electronically by completing this form & pressing the submit button.
  • Your registration will be acknowledged by email and a tax invoice forwarded to you to facilitate payment.
  • Confirmation will be made upon receipt of your payment in the post.
   
  • Complete this form and press the submit button.
  • Acknowledgment will be sent by email and confirmed in the post.
  • Alternatively, print a copy of this form
    and fax to 02 9519 2203
    or post to:     Common Ground Conferences
    PO Box K481 Haymarket NSW AUSTRALIA 2000.
 
             

Submission Section


Before pressing the submit button please enter your
full name and email address here

FULL NAME (required):

     

EMAIL (required):

  
- Once you have checked your entries on this form and completed this section, press the <Submit> button once only.
- The contents of your submission will appear in your browser window and you may print a copy for your records.
- Your submission will be processed and an acknowledgement/confirmation, together with the full submission details, will be sent to you by email.
- Should you need to make any changes, this may be done after you have received the email.

MELBOURNE | ABOUT | THEMES | SPEAKERS | PROGRAM | CALL FOR PRESENTATIONS | REGISTRATION | FESTIVALS
ACCOMMODATION | VENUE | MEDIA | COMMENTS | CONTACT | ORGANISERS | LINKS | HOME | Adelaide Archive