[Enter your information, print the form, and FAX it to: +61 (08) 8303 7534]

PAYMENT FORM 

Registration
              Name:   
  e-mail address :
 Street address :

Type of Registration:

Members Non-members
Full Member ($190) Non Member ($240)
Student Member ($85) Student Non Member ($105)
Student Member (Presenting) ($45) Student Non Member (Presenting) ($65)

There is no G.S.T. payable on registration. Registration for non-members includes 1 year membership.
Registration Total $

Dinner
                         Number at $65 per person 
Number at $55 (student rate, per student) 

End of Conference Lunch at Tandanya Cultural Institute
                         Number at $15 per person 
Number at $12 (student rate, per student) 
Dinner/Lunch Total $

TOTAL AUD$ (= Registration Total + Dinner/Lunch Total)

Payment Method

Cheque      Please make cheques out to "GSA2001 Organising"
   Credit
                           Bankcard      Mastercard      Visa

Cardholder's Name:
         Card Number :
   Card Expiry Date :