Registration and Payment Form

REGISTRATION AND PAYMENT FORM

This is an interactive Microsoft Word Registration and Payment Form for the 22nd Annual RACI Analytical and Environmental Division R&D Topics Conference.

Each registrant must submit an individual registration and payment form.

Greyed out areas on the form indicate the form fields and require text to be entered. To switch between the form fields, use the mouse to click onto the required field.

Sponsor Representative Details

Title: / First Name: / Middle Name: / Last Name:
Phonetic Pronunciation (Optional):
Position: / Company/Organisation:
Special Requirements (ie. Diet, Access, etc.).
Please note: we are catering at all events including conference:

Contact Details

Email Address: / Phone Number: / Mobile Number:
* Please include the area code (ie. 08, 03, etc)

Postal Address

Street Name / PO Box:
/ Suburb: / Post Code: / State:
Country:

Attendance Details

For catering purposes, please let us know what days you will be attending the conference.

Date

Attendance

Saturday 13th December
Sunday 14th December
Monday 15th December

Accomodation

List of nearby accomodation can be found at: http://www.flinders.edu.au/science_engineering/caps/events/raci-research-and-development-conference/accommodation.cfm

Conference and Social Activities

Please add accurately, as we can not refund once we have received payment. We cannot accept payment after the 20th November 2014. Conference pre-mixer and end of conference dinner payment to be made online by Visa or MasterCard.

Conference Activities

Required

Cost per Delegate

Conference Pre-Mixer
Saturday 13th December / Yes / No / $10
Wine Tasting Evening
Sunday 14th December / Yes/No / Free
End Of Conference Dinner
Monday 15th December / Yes / No / $80
Events Total Due: / $AUD
For payment, please click following link: https://www.flinders.edu.au/finance/ipay/
Click the “Continue to Product Catalogue” button. Scroll down to find the “School of Chemical and Physical Sciences” section and click on the box next to RACI R&D Topics Conference 2014. Scroll to the bottom and click the “Display product list” button. Make your selections and proceed to payment using Visa or Mastercard.