Text Box:

Office Use Only

Reg. No:
 
Text Box: Book your accommodation directly with RYDGES HOTEL Booking Form available on Australian Region Website www.itcaustregion.org.au and on www.rydges.com/campbelltown Text Box: SPECIAL DIET (please specify): _______________________________________ ____________________________________________________________________ Text Box: PAYMENT DETAILS – REGISTRATIONS WILL NOT BE PROCESSED WITHOUT PAYMENT All payments to be in Australian dollars and are payable by cheque, money order or by electronic transfer. Cheques; Money Orders: Make payable to ITC Australian Region Conference. Electronic Transfer: BSB 06 2121 Account No. 1066736 Exercise the option to print a receipt and attach the receipt to the registration form. Ensure that relevant details are on the receipt. Cheque Money Order Electronic Transfer Amount: $ ________________________________ Signature: ______________________________________ Disputed transaction bank fee (failed cheques) payable by the presenter. Refund Policy: Full refund available to 30 April, 2008. From 01–11 May - full refund less $50 administration fee. No refunds after 11 May, 2008. Text Box: REGISTRATION FEES Cost Member *Guest/s Total Full Registration 16-18 inclusive $250 $ $ $ Late Bird Full Registration – after 30 April $260 $ $ $ PART REGISTRATION Friday 16 PM: A’tea, Education, Welcome Dinner $ 90 $ $ $ Saturday 17 PM: Education, A’tea, Gala Dinner, Speech Contest $120 $ $ $ Saturday 17 Full Day: Education, M’tea/A’tea, Lunch, Gala Dinner & Speech Contest $190 $ $ $ Saturday 17 Evening: Gala Dinner & Speech Contest $ 80 $ $ $ Sunday 18 AM: Education, M’tea, Lunch $ 90 $ $ $ *Guest/s column: total amount for all guests Total $ $ $ $ Text Box: Registration form with payment to be sent to: Judy Barr-David, Conference Treasurer 1 Fischer Street, KINGSFORD NSW 2032 Australia Phone: (02) 9314-2610 e-mail: judybd@optusnet.com.au Receipt required - please enclose a self addressed envelope & add extra $0.50¢ to payment if envelope is not pre-stamped.

 
 
Text Box: GUESTS (if more than two guests please attach list) Name: ______________________________________ Name: ______________________________________

MEMBER SECTION           

                                                           Preferred Name on

Last Name: _____________________  First Name: ______________________ Badge: __________________

Address: __________________________________________________________________________________

City: ____________________________ State: _________ Postcode: _________ Country: _______________

Phone: (___) ______________ Facsimile: (___)______________ e-mail: ______________________________

ITC Club: ______________________________ Council: ______________ Region: _____________________

Office held Council: ______________________  Former Region President:  Yes / No    Region: ______________

Current International Office or Committee Chairman: ___________________________________________

Former International President:  year - _______       Delegate:  Yes / No          Conference First Timer:  Yes / No                

 
 

                  POWERtalk International

                                           AUSTRALIAN REGION ANNUAL CONFERENCE

                                                    16-18 May, 2008 -- Campbelltown – NSW

                 REGISTRATION FORM

               Closing date - 30 April, 2008

 

 

 

REGISTRATION FORM

Closing date 30 April, 2008

 

 

 

 
 
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