Conference Registration

ACEN 2012

29 October to 2 November 2012

Deakin University, Geelong Waterfront Campus

Personal Details

Title
First Name
Family Name
Badge Name (only if different from above)

Disclosure: In accordance with normal conference practice, your name, affiliation and contact details may be made available to delegates in the form of an attendance list. Please contact the conference organisers if this presents a problem.

Contact Details

Job Title
Division
Organisation
Address Line 1
Address Line 2
Suburb/City
State / Postal Code:
Country
Business Phones / Voice: / Fax:
Home Phones / Voice: / Fax:
Mobile
Email

Requirements

Correspondence by / q Mail / q Fax / q E-Mail
Specific Dietary Needs
Specific Access or Other Needs
I heard about the event through / q Circular in Journal / q My Professional Organisation / q Word Of Mouth

Registration Information

ABN 56 721 584 203

Prices are GST inclusive.

Conference registration / Early Bird – closes on 31st August 2012
q ACEN and NZACE Member registration – $675
q Non Member and International delegate registration - $725
q ACEN and NZACE Member day registration – $270.
Please circle Wednesday, Thursday, Friday
q Non Member and International delegate day registration - $300
Please circle Wednesday, Thursday, Friday
Standard – from 1st September to 24th October 2012
q ACEN and NZACE Member registration – $725
q Non Member and International delegate registration - $950
q ACEN and NZACE Member day registration – $300.
Please circle Wednesday, Thursday, Friday
q Non Member and International delegate day registration - $340
Please circle Wednesday, Thursday, Friday
Late – from 25th October onwards
q ACEN and NZACE Member registration – $950
q Non Member and International delegate registration - $1175
q ACEN and NZACE Member day registration – $340.
Please circle Wednesday, Thursday, Friday
q Non Member and International delegate day registration - $400
Please circle Wednesday, Thursday, Friday
Half-day Pre-Conference Workshop registration
q $200 per workshop

q ePortfolios for sustainability: evidence of standards and outcomes in a WIL environment

q Designing a Research Project and Getting it Published

q International Work-Integrated Learning

/ $ ______
Registration Fee Subtotal / $ ______
Additional tickets for social functions / Wednesday 31 October 2012
Networking Evening
______Number of Additional Tickets ($45)
(The Networking Evening is included in full registration)
Thursday 1 November 2012
Conference Dinner
______Number of Tickets ($122)
(Conference dinner is included in full registration) / $ ______
Social Function Subtotal / $ ______

Payment Methods

E-mail
Mail / Deakin Event Management Services
Deakin University
Geelong Waterfront Campus
Geelong VIC 3217
Australia
Fax / +61-3-5227-8157

Payment Details

Total Amount Payable
(includes 10% Australian Goods and Services Tax) / $ ______

q Please find attached a cheque/bank draft for $AU ______made out to “Deakin University”

q Please Charge my credit card

q MasterCard / q Visa
Authorised amount / $AU ______
Cardholder Name
Card Number
Expiry Date / ______/ ______
(MM / YY)
Signature / Date______/ ______/ ______
(Day / Month / Year)

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