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SECTION A
Section A: Delegate Details
Title:
Mr
Mrs
Ms
Miss
Dr
First Name:
Last Name:
Position / Organisation:
Mailing Address:
Suburb / Town:
State:
Postcode:
Phone(w):
Mobile:
Fax:
Email:
Section B: Addition Information
Dietary Requirement:
Please indicate if you are primarily a:
Student
Academic
Practitioner
Other:
Please indicate how you heard about this conference:
OSWA Email
OSWA Internet Site
State Group Email
Word of Mouth
AASW
Other
Section C:
Registration
Please tick appropriate box
Full conference registration
(Early bird closes Friday 7 October 2011)
Registration includes: Morning/afternoon tea and lunch, satchel, handouts and attendance to all sessions.
If you are attending the COSA conference you will be requested to show proof of purchase. Failure to do so may result in extra charges.
Students will also be required to provide ID.
OSWA member (Early Bird $220)
OSWA member (Standard $240)
OSWA member attending COSA# (Early Bird $120)
OSWA member attending COSA# (Standard $140)
Non OSWA member (Early Bird $280)
Non OSWA member (Standard $300)
Non OSWA member attending COSA# (Early Bird $180)
Non OSWA member attending COSA# (Standard $200)
Full-time Student (Under/Post Grad)+ (Early Bird $100)
Full-time Student (Under/Post Grad)+ (Standard $120)
One Day Only * OSWA Member (Early Bird $120)
One Day Only * OSWA Member (Standard $140)
One Day Only * Non OSWA Member (Early Bird $180)
One Day Only * Non OSWA Member (Standard $200)
Section D: Social Program
Conference Dinner- Friday 18 November 2011
Please Note: Dinner Tickets are $70 each
Purchase Dinner Tickets (enter the number of tickets to purchase):
Section E: Payment
SECTION C Total:
SECTION D Total:
Total Amount Due:
Please Note.
If you choose Direct Deposit ...
* Be sure to
transfer the "Total Amount Due"
into the bank account details provided below.
Please state your full name and conference on direct deposit reference, for example, Mary Smith Conference
Choose your payment Method:
Pay Pal
Direct Deposit
ABN: 25 332 146 091 |
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