Registration Form I CV26 Sydney

31 Augus t – 4 September 2015

Note: Registration clo ses on 17 August 2015

Title / First Name / Last Name (Surname)
Primary Registrant
Accompanying Person 1
Accompanying Person 2
Unit :
Number / Street :
City / Suburb :
Postcode & State or Region :
Country :
Email:
Telephone Number: / + +
(country code) (area code) (phone number / mobile)
Vexillological Association:
Position:
Any comments:

Fees – please see “Fees & Registration” page on Congress website for details of events.

Please complete “Number” for each person, even if item has no charge – we need it for catering

Item / Number / x Price / Total A$
Early Registration / - / closed / -
Normal Registration / A$ 250
Companion Registration / A$ 60
Companion Tour – Opera House / A$ 75
Companion Tour – Sydney Beaches / A$ 50
Companion Tour – Taronga Zoo / A$ 85
Harbour Cruise (part of registration)
(includes wine, beer & soft drink and canapés) / No Charge / -
Canberra Excursion (includes lunch & dinner) / A$ 145
Closing Dinner (includes wine, beer & soft drink) / A$ 90
FOTW meeting (includes wine, beer & soft drink) / No Charge / -
Display tables (one only per delegate) / No Charge / -
GRAND TOTAL / - / -
My companion or I have special dietary requirements – please detail:

FLAGS AUSTRALIA

Congress Treasurer

PO BOX 5245

PINEWOOD VIC 3149

AUSTRALIA

Phone / Fax 61+3+98844434

ICV26 Payment Arrangements

Please return Registration Form and Payment Form to

or post to address above or fax to number above

Payment method:Cheque / Money Order or Direct Credit or PayPal

International Cheque (A$ only) or Credit Card or International Money Transfer

NAME of Primary Registrant

/

DATE:

of registration /

TOTAL AMOUNT

from front page *

/

A$

Payments may be made by cheque or money order to Flags Australia at the above postal address.

Payments by international cheque / bank draft must be in A$ drawn on a bank branch in Australia.

Alternatively, direct credit may be made to the following bank account. Please put the delegate’s surname as the reference comment in the payment:

Bank: Westpac Banking Corporation

BSB Number: 032087

Account Number: 352557

Account Name: Flags Australia

For International Money Transfersyour bank will need our bank’s SWIFT Code (similar to an ICAN). Your bank will charge fees for the transfer, likely to be equivalent to A$20 - A$30.

BIC/ SWIFT CODE: WPACAU2S

Please send an email / or post/fax this form to confirm payment details

if you use PayPal, Direct Credit or International Money Transfer

CREDIT CARD DETAILS: VISA card or MasterCard only

Account Number (all digits please):

Signature: Expiry Date (MM/YY)
Print Name: (as it appears on card) / CCV:

Credit card payment may be made by fax to: 61+3+98844434

Please note: Credit card will be processed in A$ by National Flags on behalf of Flags Australia