Application Form Fee Waiver for Delegates from Developing Countries and for Postgraduate

Application Form
Fee Waiver for Delegates from Developing Countries and for Postgraduate Students
Successful applicants will be need to cover all travel, accommodation and living expenses.

Family Name: Given Name Title:

Organisation:

Postal Address:

Suburb/Town/City: State: Postcode:

Telephone: Facsimile:

Email:

Name Badge

Special Requirements

Please advise if you have any special requirements, for example dietary or mobility:

Registration
Category / þ
Developing Country
Postgraduate Student*
*Attach evidence of your current student enrolment status.
/ Social Functions
Please indicate if you wish to attend the following functions.
Function / þ
Registration Drinks
Government House Reception
Conference Dinner
Abstract Submission
Applicants for a fee waiver must submit an abstract before sending this form. This can be for either a talk or a poster presentation.
þ
I have submitted an abstract via the conference web site
Curriculum Vitae
þ
I have attached a one page curriculum vitae

Accommodation:
Refer to the web site for the accommodation options, rates and full conditions. Accommodation costs for successful applicants are not covered by the conference. See the accommodation page on web site for budget accommodation options.

Hotel / Room Configuration / Cost per Night / þ
Hotel Grand Chancellor - Harbour View / Single / Twin / Double / 200.00
Hotel Grand Chancellor - Mountain View / Single / Twin / Double / 200.00
The Old Woolstore / Single/Double / 160.00
The Old Woolstore / Twin / 160.00
The Old Woolstore / Studio / 175.00
The Old Woolstore / 2 Bedroom Apartment / 255.00
Hadleys Hotel / Single/Double / 160
Hadleys Hotel / Twin / 160
Arrive:
Depart:
Sharing with:
Non-smoking:
Comments:

Accommodation Guarantee

¨ Credit card: The card details will be passed to the hotel as a guarantee and guest will need to pay on check-out. See the web site for conditions.

Card Type: Visa ¨ MasterCard ¨ Diners ¨ Amex ¨ Use card listed below ¨

Card Holder:

Card Number: Expiry Date:

Signature:

¨ Pre-payment: following amount will be included in the tax invoice we send back. Accommodation pre-payment must be received 30 days prior to the conference.

¨ One night per room

¨ Full accommodation amount

Send the completed form to: Conference Design Pty Ltd
: ( 03 6224 3773 Ê 03 6224 3774 * PO Box 342, Sandy Bay TAS 7006