[Enter your information, print the form, and FAX it to: +61 (2) 9385 1483]

PAYMENT FORM for GSA 2002 and Gene Mapping

Registration
Name:
 e-mail address:
Street address:

Type of Registration: Either BOTH GSA 2002 and Gene Mapping Workshop (GMW),
or either conference alone TICK THE BOX BELOW

Members Late registration	Non-members Late registration
Full Member BOTH GSA & GMW ($300)	Non Member BOTH GSA & GMW ($350)
Full Member GSA or GMW ONLY ($250)	Non Member GSA or GMW ONLY ($300)
Student Member BOTH GSA & GMW ($150)	Student Non Member BOTH GSA & GMW ($175)
Student Member GSA ONLY ($125)	Student Non Member GSA ONLY ($150)
Student Member GMW ONLY ($125)	Student Non Member GMW ONLY ($150)
Day registration 9th, 10th ($100) 11th, 12th ($150) Students half price	Day registration 9th, 10th ($120) 11th, 12th ($150) Students half price

There is no G.S.T. payable on registration.

Registration Total $Day or conference

Dinner (at Crowne Plaza Hotel in Coogee with music and dancing to The Major Groove)
Number at $60 per person  Number at $45 (student rate) 
Do you require a vegetarian meal yes no

Dinner Total $

TOTAL AUD$ (= Registration Total + Dinner Total)

Payment Method

Cheque      Please make cheques out to "GSA 2002 Conferences"
   Credit
                           Bankcard      Mastercard      Visa

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

NOW PRINT THIS PAGE AND FAX IT TO: +61 (2) 9385 1483
or mail it to GSA Conferences, BABS (Biochem), Univ NSW, Sydney NSW 2052