distance
education:
an open question?
11-13
September 2000 |
|
registrationform |
competition
collaboration
continuity
change
|
Please
print and complete the registration form and post with you payment to:
Conference
Secretariat
Karen English
International Relations
University of South Australia
GPO Box 2471
Adelaide
South Australia 5001
| Delegate
Details
(Office use only Reg No) |
|
| Title
(Dr/Prof/Mr/Mrs/Ms) |
|
First/Given
Name |
|
| Surname/Family
Name |
|
| Institution/Organisation |
|
| Department |
|
| Address |
|
| Town/Suburb |
|
| State |
|
Postcode |
|
| Country |
|
| Telephone |
|
Facsimile |
|
| Email |
|
| Prefered
name for badge |
|
A.
Registraton Fees (Note all prices are quoted in Australian Dollars)
| Early
Registration (by 28 July 2000) |
$630 |
|
|
| Registration
(after 28 July 2000) |
$670 |
|
| Workshop
1 |
$160 |
|
| Workshop
2 |
$200 |
|
| Post
Conference Workshop |
$
80 |
|
| Registration
Fees Sub Total A: |
A |
$ |
B.
Accommodation (Please tick appropriate box)
| Novotel
Adelaide on Hindley |
$165 |
|
|
| Raddisson
Playford Hotel |
$180 |
|
| Saville
Apartments Hotel |
$119 |
|
one
bedroom |
$146 |
|
two
bedroom |
| Grosvenor
Vista Hotel |
$
80 |
|
$
95 |
|
$130 |
|
|
| Festival
Lodge Motel |
$
72 |
|
$
83 |
|
|
| Adelaide
Paringa Motel |
$
77 |
|
$
94 |
|
|
Room
Type (single/double/twin) |
|
|
Twin
Share with NAME |
|
| Note
if you are twin sharing a room only one person is required to
pay the deposit |
|
Date
IN |
|
Date
OUT |
|
No
of Nights |
|
Accommodation
Deposit Sub Total B:
(one night's deposit, balance payable direct to hotel) |
B |
$ |
C.
Social Activities (Please tick appropriate box)
| I
will be attending the Welcome Cocktail Party on Sunday 10
September |
|
| I
will NOT be attending the Welcome Cocktail Party on Sunday 10
September |
|
| Additional
Dinner Tickets @AUD$80 (Tuesday12 September) |
$ |
| Name
of additional person attending dinner |
|
| Socal
Activities Sub Total C: |
C |
$ |
| Registration
Fee and Workshop Fee/s (if applicable) Sub Total |
A: |
$ |
| Accommodation
Deposit Sub Total |
B: |
$ |
| Socal
Activities Sub Total |
C: |
$ |
| |
Grand
Total: |
$ |
| Please
find enclosed cheque/bankdraft made out to University of South
Australia |
|
| or
please charge my credit card |
|
Visa |
|
Mastercard |
|
Bankcard |
|
|
| Card
No |
|
|
|
|
- |
|
|
|
|
- |
|
|
|
|
- |
|
|
|
|
| Expiry
Date |
|
| Cardholders
Name |
|
| Signature |
|
Special
Requirements
| I
have the following special dietary requirements : |
|
| I
require the following disability assistance: |
|
|