Australasian Acupuncture & Chinese Medicine Annual Conference

AACMAC BRISBANE 2017

Australasian Acupuncture & Chinese Medicine Annual Conference

5 – 7 May 2017

Brisbane Convention and Exhibition Centre, Australia

REGISTRATION FORM – DELEGATES

PERSONAL DETAILS
TITLE
Prof Dr Mr Ms Mrs Miss / FAMILY NAME
/ GIVEN NAMES
/ AACMA MEMBER NO
PHONE / FAX / EMAIL
ADDRESS
SUBURB/TOWN/CITY / STATE / POSTCODE/ZIP
COUNTRY / Are you also submitting an abstract for oral or poster presentation? / Yes
DELEGATE REGISTRATION
3 DAY TICKET / FRIDAY 5 MAY SATURDAY 6 MAY SUNDAY 7 MAY / $
2 DAY TICKET (TICK TWO BOXES) / FRIDAY 5 MAY SATURDAY 6 MAY SUNDAY 7 MAY / $
1 DAY TICKET (TICK ONE BOX) / FRIDAY 5 MAY SATURDAY 6 MAY SUNDAY 7 MAY / $
COCKTAIL PARTY – FRIDAY 5 MAY
CONFERENCE DELEGATE / I WILL ATTEND THE COCKTAIL PARTY / NO CHARGE
ADDITIONAL TICKET(S) / NUMBER OF ADDITIONAL TICKETS: (see over page for price) / $
NAME(S) FOR ADDITIONAL TICKETS ONLY
GALA DINNER – SATURDAY 6 MAY
CONFERENCE DELEGATE / I WILL ATTEND THE GALA DINNER / $
ADDITIONAL TICKET(S) / NUMBER OF ADDITIONAL TICKETS: (see over page for price) / $
NAME(S) FOR ADDITIONAL TICKETS ONLY
TOTAL PAYABLE / $
Special Requirements Vegetarian Vegan Coeliac Other (Please provide details)

PAYMENT DETAILS – SEE NEXT PAGE FOR DELEGATE RATES

PAYMENT:The delegate fee must be paid in full before conference registration will be confirmed. Payment must be made in Australian dollars (AUD).
Cheques/bank drafts/money orders to be made out to AACMA. Additional charges will apply if payment is made in other currencies.
CANCELLATION FEES: Please see page over for the cancellation policy.
I enclose $ being payment via Cheque/Money Order OR Credit Card Visa/MasterCard AMEX Diners (5% surcharge for Diners Club)
I authorise the withdrawal of / $ / from the following card:
Cardholder’s Name / Card Number
Expiry Date MM/YY / / / Signature

In accordance with the Australian Privacy Act 1988, all personal information provided will be treated as confidential and used by the conference organiser to register you for conference functions and to keep you informed of conference information. All delegates will be supplied with a personalised lanyard (identification tag) displaying name and State/Country. This must be worn at all times during the conference and the organiser reserves the right to refuse entry to any person who fails to wear or display their personalised lanyard. A list of delegates with state/country will be included in the conference pack.
It is a condition of registration and entry to the conference that you agree to the above terms and conditions for the use of your personal information.

Name / Signed / Date DD/MM/YY / / /

Please forward completed form with payment to AACMAC Brisbane 2017: PO Box 1635, COORPAROO DC QLD 4151 AUSTRALIA
FAX +61 7 3394 2399 or email

AACMAC BRISBANE 2017

Australasian Acupuncture & Chinese Medicine Annual Conference

5–7 May 2017

Brisbane Convention and Exhibition Centre, Brisbane, Australia

PAYMENT PLAN BY INSTALMENTS – AACMA MEMBERS ONLY

Members are able to take out a Payment Plan to cover the conference attendance costs.

Please complete the registration form on the reverse side and then complete the section below.

AACMAC BRISBANE 2017 CONFERENCE PAYMENT BY INSTALMENTS

Authority to establish a periodical payment facility for the pre-payment of AACMAC Brisbane 2017 conference fees payable to the Australian Acupuncture and Chinese Medicine Association Ltd ABN 52 010 020 390.

EARLY BIRD REGISTRATIONS ONLY – TO BE PAID IN FULL BY 3 MARCH 2017
Please charge my credit card account as indicated below on the 15th day (or next business day) of each month from November 2016 to March 2017 inclusive with the sum indicated below as pre-payment of my AACMAC Brisbane 2017 conference fees.
Conference fees as per TOTAL PAYMENT on the REGISTRATION FORM (reverse side) $ ______
Divide the total figure by 5 – this is the amount to be paid each month for 5 months$ ______
CREDIT CARD DETAILS
Name of Card Holder______Card Number: ______
Visa/MasterCardAMEX Diners Club* 5% surcharge applies for Diners Club payments
Exp Date __ __ /__ __ Signature______
CHEQUE & BPAY PAYMENTS
For cheque and BPAY pre-payments, complete and submit the forms and post/program instalments by mail as per the formula.
CANCELLATION POLICY

The delegate fee must be paid in full before conference registration will be confirmed.
Payment must be made in Australian dollars (AUD).
Cheques/bank drafts/money orders to be made out to AACMA.
Additional charges will apply if payment is made in other currencies.

CANCELLATION FEES:

$75 for cancellations notified by 15 February 2017;
$125 for cancellations notified between 15 February 2017 and 15 April 2017 (including the dates).
There is NO REFUND on cancellations advised after 15 April 2017.
There is NO REFUND once a letter of invitation for visa purposes has been issued.

AACMAC BRISBANE 2017

Australasian Acupuncture & Chinese Medicine Annual Conference

5 – 7 May 2017

Brisbane Convention and Exhibition Centre, Australia

KEY DATES

ABSTRACTS & PAPERS / DELEGATE REGISTRATION
28 February 2017 / Closing date for abstract submission / 3 March 2017 / Early bird registration closes
7 April 2017 / Presenters notified / 21 April 2017 / Regular registration closes
17 April 2017 / Final program released

Early Bird Registration (pay in full by 3 March 2017)

ITEM / Member / Student Member / Non-Member
Conference – 3 day ticket / $545.00 / $355.00 / $760.00
Conference – 2 day ticket / $490.00 / $320.00 / $685.00
Conference – 1 day ticket / $410.00 / $265.00 / $575.00
Cocktail Party - conference delegates / FREE / FREE / FREE
Cocktail Party – non-delegates / $70.00 / $45.00 / $75.00
Gala Dinner (per ticket) / $125.00 / $80.00 / $160.00

Regular Registration (pay in full by 21 April 2017)

ITEM / Member / Student Member / Non-Member
Conference – 3 day ticket / $655.00 / $425.00 / $915.00
Conference – 2 day ticket / $590.00 / $385.00 / $825.00
Conference – 1 day ticket / $510.00 / $335.00 / $715.00
Cocktail Party - conference delegates / FREE / FREE / FREE
Cocktail Party – non-delegates / $75.00 / $50.00 / $75.00
Gala Dinner (per ticket) / $150.00 / $95.00 / $160.00

The Delegate Registration Fee includes admission to all conference lectures and workshops, conference pack, Book of Abstracts, Conference Program, refreshments and lunch during breaks (afternoon tea: Friday to Sunday; morning tea & lunch: Saturday & Sunday) and Cocktail Party (one ticket).

CANCELLATION POLICY

• The delegate fee must be paid in full before conference registration will be confirmed.

• Payment must be made in Australian dollars (AUD).

• Cheques/bank drafts/money orders to be made out to AACMA.

• Additional charges will apply if payment is made in other currencies.

• Early Bird fee must be paid in full before 3 March 2017.

CANCELLATION FEES:

• No cancellation fee for cancellations notified on or before 3 March 2017.

• $150 for cancellations notified between 3 March 2017 and 31 March 2017.

• There is NO REFUND on cancellations advised after 31 March 2017.

• There is NO REFUND once a letter of invitation for visa purposes has been issued.