Please Email Completed Form (2 Pages) To

Organisation
Name of person co-ordinating registrations
Position Held
Postal Address
City / State / Postcode
Telephone
Email(for tax invoice and receipts)
REGISTRATION
Registration Fees: Group registration fees only apply when 5 or more delegates employed by the same organisation are registered at the same time.
Category / Earlybird / Standard / Late
Registration
Group full registration / $1345 / $1445 / $1545
Pre-conference Workshops and Post-conference Site Visit
Full Day / $650 / $650 / $650
Half Day / $350 / $350 / $350
Site Visit / $80 / $80 / $80
Earlybird registration close: 31 July 2015; Standard registration close: 31 August 2015; Late registration open: 1 September 2015
PAYMENT ABN: 60 383 512 852 All fees are in Australian Dollars and include GST
Total Fee Payable / Registration fee: $ x ______delegates = $
Workshop fee:
Full day workshop: $ 650.00 x ______delegates = $
Half day workshop: $ 350.00 x ______delegates = $
Site visit fee: $ 80.00 x ______delegates = $
Conference dinner $ 160.00 x ______delegates = $
TOTAL PAYABLE: $______
 Credit card payment
Card Type (Visa, MasterCard or American Express)
Card number
Expiry date
Cardholder name
Cardholder signature

or  Please send me an invoice

or  EFT: Bank of South Australia BSB: 105-146 Account #: 026 265 440Account Name: Cleanup Conference (Please include organisation name on transfer)

DELEGATE DETAILS Please complete details for each person attending and indicate which Workshop or Site Visit each person is attending
First Name / Last Name / State / Email (you must complete this field) / Special Requirements (dietary, etc) / Conference Dinner (Indicate # of tickets) / Workshop(s)
Indicate workshop # / Site Visit
Indicate site name
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Please email completed form (2 pages) to

or

Fax completed form (2 pages) to +61 (0) 8 8379 8177

Conference Secretariat: Plevin and Associates Pty Ltd PO Box 54 Burnside South Australia 5066 Tel: +61 8 8379 8222 Fax: +61 8 8379 8177 Email: