REGISTRATION FORM
Innovative Smart Grid Technologies Asia Conference 2016 Secretariat
ABN: 78 392 954 223
GPO Box 3270
Sydney NSW 2001
Phone: +61 2 9254 5000 • Fax: +61 2 9251 3552
Email:
Web:http://sites.ieee.org/isgt-asia-2016/
Please complete one form for each registrant •
All fees are quoted in Australian dollars (AUD) and are inclusive of GST •
Section 1 – PERSONAL DETAILS
Title______
First Name ______Last Name______
Position______
Organisation______
Address ______
______City/Suburb______
State ______Postcode______Country______
Telephone* ______Facsimile* ______*Country + Area Code required
Email Address ______
Dietary/Special Requirements for the Conference and Social Functions
¨ Vegetarian ¨ Vegan ¨ Gluten Free ¨ Lactose Free ¨ Halal
¨ Other
Section 2 – REGISTRATION FEES
Please indicate your registration category by ticking the appropriate box
Rate / Please tickMember IEEE PES – Full Registration / $990.00
Non Member IEEE PES – Full Registration / $1200.00
Post Graduate – Full Registration / $660.00
Single Day Registration / $500.00
Full Day Tutorial Registration / $300.00
Half Day Tutorial Registration / $180.00
Women In Energy Lunch / $20.00
REGISTRATION FEE TOTAL: $______
Section 3 – SOCIAL FUNCTIONS
The conference social program will be a time for delegates to catch up with old friends and meet new ones in a relaxed atmosphere, away from the hustle and bustle of the conference sessions.
Welcome Reception
Date: Monday 28 November 2016 - University House Woodward
Time:
¨ Ticket (Inclusive for Full delegates) ______x $0 $______
¨ Additional Ticket ($60 including GST per person) ______x $60 .00 $______
Conference Dinner
Date: Wednesday 30 November 2016 - Sea Life Melbourne Aquarium
Time:
¨ Ticket (Inclusive for Full delegates) ______x $0 $______
¨ Additional Ticket ($165.00 including GST per person) ______x $165 .00pp $______
SOCIAL FUNCTIONS TOTAL: $______
Section 4 – SUMMARY OF PAYMENTS
Section 2 Registration Fees $______
Section 3 Social Functions $______
TOTAL PAYMENT ENCLOSED: $______
METHOD OF PAYMENT - All payments must be made in Australian dollars.
Credit card – If you wish to pay by credit card, please complete the following:
¨ Visa ¨ MasterCard
Credit Card Number ¨¨¨¨ ¨¨¨¨ ¨¨¨¨ ¨¨¨¨ CCV¨¨¨
Card Holder’s Name ______
Expiry Date______/______Signature______
§ Please note that debits to your credit card will appear as ICMS Australasia on your credit card statement.
¨ I consent to the collection, use and disclosure of information (excluding credit card details) provided in this registration form in
accordance with and for the purpose outlined above.
Signature: ______Date:______