Registration
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Registration |
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Title (Prof, Dr, Mr, Ms, Mrs, Miss):..................................................... Family Name:..................................................................................... First Name:......................................................................................... Organisation:............................................................................................... Postal Address:.................................................................................. City:...…………………............State:…………..................................... Postcode:...............................Country:............................................... Business Tel:.........................Business Fax:...................................... Email:.................................................................................................. Dietary Requirements:....................................................................... Name as you would like it to appear on your name badge: ............................................................................................................ Name of accompanying person:........................................................ Profession (tick all which apply): Doctor Nurse Allied Health Trainee Paediatrics GI ID Nutrition Academic Scientist Early Bird Registration: $A650 ($A30 reduction for paid up CAPGAN members would reduce the early bird fee to A$620) EXTENDED UNTIL 28th FEBRUARY 2001 Full Registration: $A750 Full Day Registration: $A250 Please indicate which day you will be attending: Thursday Friday Saturday Welcome Reception: No of tickets Congress Dinner: No of tickets @ $A100 Number of Nights............................. Please refer to the Congress Program to see which sessions you wish to attend. Please circle only one session for each day. Thursday 26th April _ 10.30am-12.00pm Session 1 Session 2 Session 3 Session 4 Friday 27th April _ 10.30am-12.00pm Session 1 Session 2 Session 3 Session 4 Saturday 28th April_ 10.30am-12.00pm Session 1 Session 2 Session 3 Session 4 Registration Fees $AUD Social Function Tickets $AUD TOTAL OWING $AUD Amount Paid with this Form $AUD An invoice for your accommodation will be sent out upon receipt of registration. Full payment is required prior to the Congress to secure arrangements. Registrations must be accompanied by payment, with faxes only being accepted when accompanied by credit card payment. Please make cheques or money orders payable to: "Convention Catalysts Int" Send Form and Payment to: Convention Catalysts Int, PO Box 2541, DARWIN NT 0801, Australia Alternatively please fax back registration form with credit card details to Convention Catalysts on +61 8 8941 1639 Credit Card Type: MC / BC / Visa / Amex / Diners Name on Card. Card Number: ££££ ££££ ££££ ££££ Card Expiry Date: I hereby authorise you to charge $ to my credit card. Signature: All registration prices include Goods & Services Tax (GST) |
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Questions or comments to info@capgan.org or Fax: +852 26360020 or Tel: +852 26322861Last modified: December 10, 2001 |