Registration Form - the Downloadable Registration form is available here 

DELEGATE DETAILS

PIN	automatically allocated
Dr Mr Mrs Ms Prof First Name*		Last Name*
Position*
Organisation*
Street Address*
Address (cont.)
City*
State*		Zip/Postal Code
Country*
Work Phone* Please include country and Area code		FAX
Mobile
E-mail
REGISTRATION Registration fees include all catering on each day of conference at venue, please select appropriate registration type. Registration Fee (all prices in Australian dollars -- for current exchange rates click here)
Early Conference Package: Member*  by 1st May          $470.00 Early Conference Package: Non Member - by 1st May   $535.00 Conference Package: Member*  after 1st May     $535.00 Conference Package:  Non Member - after 1st May       $595.00 Presenter Registration  by 31st March   $420.00 Student Registration      $375.00 None Selected                 $ Student registration requires documentation The deadline for payment is 1st June 2006 Special Dietary Requirements - Please specify: CONFERENCE EVENTS The Conference Dinner Tickets are available @$110.00                                     Number  $ Will you be attending the conference dinner? Yes
Do you agree to have your contact details available to other delegates? Yes No PAYMENT TOTALS Conference Package:                                                                                            $ Conference Dinner tickets     :                                                                                $ Total Cost (all costs include GST)                                                                       $ * Early Bird Discount applies only to Full Fee Conference Package. If paying for more than one delegate, please specify  names of delegates who are being paid on a separate document and attach to the name of the person/organisation  who is paying. A confirmation notice will be sent to verify details N.B. Each delegate must submit a separate registration form in order to be registered. PAYMENT OPTIONS: Cheque Please enclose with registration form (make cheque payable to Victoria University) Payment: Please Invoice my Organisation       B/Card     M/Card     Visa: Cardholder Name: Card Number: Expiry date: Invoice Details: Cheques and Purchase Orders are to be made payable to  VICTORIA UNIVERSITY (ABN 83 776 954 731) and sent to: ICIP Conference 2006 Victoria University Cayering and Conferences PO Box 14428. Melbourne VIC 8001 Fax: (03) 9919 7199 Email: conferences@vu.edu.au PLEASE NOTE: Registrations must be received by close of business 1st June 2006 This registration form becomes a Tax Invoice once all Delegate Details are completed. Registration will not be complete until payment is received at the address above by the due dates. Cancellations must be received in writing at the Conference Office. Cancellations received before1st May 2006  will receive a full refund less a $100 administration fee. Cancellations received after 1st May 2006 will normally  receive no refund. Transfer of registration from one person to another is possible if original delegate is unable to attend. For more Conference information, please see the conference brochure and visit the following web address: http://conferences.vu.edu.au/icip Victoria University will only use the information contained within this registration form for the purpose of organising the  conference unless required to do otherwise by Law or with your express approval