Conference Registration

Central Queensland University

ABN: 39 181 103 288

Part A: On-line Registration

Personal Details:
  Family Name:
  First Name:
  Title: Mr   Ms   Mrs   Dr   Prof
  Name to appear on badge:
  Organisation to appear on badge:
  Street Address or Post Office Box:
  City:
  State or Province:
  Postal Code or ZIP Code:
  Country (if not Australian):
  Business Phone:
  Home Phone:
  Fax:
  Email:

We would like to distribute your contact information to other conference attendees as a valuable addition to the benefits of this conference. Can we distribute your contact information?
(Please choose one)

I Do give permission for my contact information to be shared with conference attendees.
I Do Not give permission for my contact information to be shared with conference attendees.
  Special assistance for disability required: Please contact me
Registration type:
 
Early Bird Registration $A495.00
Normal Registration $A550.00
Developing Country Registration $A264.00
Community Group / NGO / NFP Registration $A264.00
Student ** $A187.00
Day Rate Registration $A242.00
  Please note: All prices include GST.
 

There will be a limited number of subsidised places for people in the following categories:

Developing Countries $264.00
Community Group / Non-profit / NGO representatives $264.00
Full time Students pursuing research in a University in a field related to the conference topics $187.00 **

**Assistance may be required in support roles for the conference
 

Accomodation requests after Dec. 1, 2003 should be made directly to Rydges

The contact number for Rydges is (07) 5491 0333 and ask for Jemima Harden - explaining you are from ITiRA/RACs or the website is  http://www.rydges.com.oasis

Accommodation must be prepaid.


Please note: All prices include GST.

Total cost:
$

 
Please indicate the method of payment you intend using:
Cash     Cheque or Money Order    Credit Card

Please SUBMIT this form electronically (click on the Submit Registration button below) before completing the payment details section.

Part B: Payment Details

This form (Parts A and B) when completed is a tax invoice for GST purposes.

Cash AUD $
Cheque or Money Order AUD $
(Payable to "Central Queensland University - ITiRA")
Credit Card
Date: _____/_____/_____
Please debit my Credit Card AUD $
Being payment for:  ITiRA Conference 
Cardholder's Name: __________________________
Cardholder's Number: ______ ______ ______ ______
Expiry Date: _____/_____
Credit Card Type:
  Mastercard Bankcard
  Visa AMEX
Cardholder's Signature: __________________________

Now fax or mail this completed form (Parts A and B) to the following address.
Fax:
(61-7-4930 9729)
Address: 
ITIRA2003
Faculty of Informatics & Communication
Building 19
Central Queensland University
Rockhampton, QLD 4700

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