REGISTRATION FORM AND TAX INVOICE

P.O. Box 6396
East Perth
WA 6892 AUSTRALIA

Direct bank transfer to:

Account Name:                   Ausit  National

BSB:                                   033 002

Account Number:                134 054

Full Name and Title:       …………………………………………………………………………

E-mail Address:…………………………………………………………………………………

Postal Address:…………………………………………………………………………………

         ……………………………………………………………………………………………..

Do you require an AUSLAN interpreter?   Yes      No

Do you require a special diet?       ¨ Vegetarian      ¨ Halal/Kosher

¨ Other:  ……………………………………………………………………………………….

Will you be attending the Conference Dinner on 5 November?     Yes       No
(additional fee of $95 applies)

 

I am paying for:	AUD
AUSIT Member – Early registration (before 31 July)	195.00	________
AUSIT Member – Registration (after 31 July)	245.00	________
Non-AUSIT – Early registration (before 31 July)	220.00	________
Non-AUSIT – Registration (after 31 July)	270.00	________
Student - Please indicate course, institution and status (full/part time)	95.00	________
Corporate Ticket (two or more attendees), per person	205.00	________
Conference Dinner ___ persons @ AUD 95.00 per person		________
TOTAL	$	________

 (Prices include GST)

 

PAYMENT METHOD

[_]  Cheque/money order payable to AUSIT

[_]     Direct bank transfer (please attach proof, e.g. electronic or paper receipt issued by your internet banking service at the end of the internet transfer procedure)

[_]  Credit Card

                       [_]  Visa

                       [_]     Master Card

Card No: _ _ _ _  _ _ _ _  _ _ _ _ _ _ _ _

Expiry Date: _ _ / _ _     Security CCV: _ _ _       *          

Name on Card: ……………………………………………………………………………

I authorise AUSIT to charge my credit card the amount of                                   

AUD …………. AUSIT conference registration

AUD …………. AUSIT conference dinner

AUD ………….TOTAL

 

SIGNATURE………………………………………..

 

NOTE: Owing to AUSIT policy, once payment has been received, we are unable to offer any full or partial refunds. Thank you.

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* For Visa or Mastercard holders the CCV number is the three digit number printed after your card number on the signature strip on the reverse side of your card.