ASBS 2016 Conference Payment Form

ASBS 2016 Conference Payment Form

Please complete the following with the same details you used in your online conference registration! http://asbs2016.ourplants.org/registration-abstracts/

Please complete the following with the same details you used in your online conference registration
Your email (used for registration):
Your name:
Contact name and phone *:

* this number is for any payment enquiries (and name of contact if that is not the registrant named above).

Conference registration includes morning and afternoon teas, light lunches, conference materials and the welcome function. Please note extra payments are required for the conference dinner, end of conference BBQ and the field trip day.

Conference Fees
Standard Registrations / closes 2 September / Tick selection ü / Insert $
Members / $300
Non-members / $350
Students / $250
Day registrations / anytime before
2 September
Day registration / $150
Conference Events
Welcome function / Free
Dinner / $70
BBQ / $35
Field Trip / $75
TOTAL / AUD$

ASBS 2016 Conference Payment Form p2

Your email (as on previous page):

Payment Options*

Payment by bank transfer, credit card or cheque.

Total payment amount (from table on previous page): AUD$

1. Bank Transfer

Important: include your (registrants) full name and ‘ASBS2016’ in the payment reference

Commonwealth Bank of Australia
BSB: 063-243
Account Number: 00901958
Swift Code (for overseas transactions): CTBAAU2S

2. Credit Card Payments

Cardholder name:

Cardholder address:

Visa / MasterCard (please circle)

Credit Card No.: ______/ ______/ ______/ ______

Expiry Date: ______/ ______(mm/yyyy)

Signature of card holder:

3. Cheques (note it may take some time to process cheques)

Cheques should be made payable to Australasian Systematic Botany Society Inc.

Please forward cheques to:

John Clarkson, Treasurer ASBS Inc.

PO Box 975, Atherton QLD 4883, AUSTRALIA

Please complete this form and return both pages by email to:

*note if this payment is for multiple people please complete multiple forms, leaving all but one payment page blank. Submit all forms together with a note below on the payment page (this one) that includes the names of all the people the payment covers.