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 tick
Member 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:______