Australian EW, IO & Cyber Convention 2012

Hilton Adelaide, Adelaide, 16 – 17 April 2012

Exhibitor Registration Form

Registration Form/Tax Invoice ABN: 85 430 234 504

(Please print clearly)

·  Each booth booking includes one trade pass registration (trade display entry & daytime catering: morning tea, lunch & afternoon tea, only) and one complimentary full registration per booth (1 of each for single booth and 2 of each registrations for double booth)

·  Exhibitor Day Passes for additional representatives at a cost of $75 per person per day for stand only attendance which includes morning and afternoon teas and lunches. Social functions must be booked and paid for separately and are not included in this registration type. Please indicate if attendees will be requiring social function tickets with registration information below. (See page 3 for costs & payment details)

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Please note exhibitors / sponsors registering as full or complimentary full delegates

need to complete the delegate registration form in the Registration Brochure

STEP 1: Registration Fees

Name for main contact onsite [For office use only] Reg No AOC2012/……..

Title: First name: Surname:

Organisation: Position

(as you wish it to appear on your namebadge)

Address: City:

State: Postcode: Country:

Mobile: Fax: Email:

Please circle registration type: Comp Full Registration/Comp Trade Pass/ Exhibitor Day Pass / Other Registration Type (Day registrations only: Circle day/s attending @ $75 per day: Monday Tuesday

Social Functions: Networking Reception(inc: full comp registration only): YES/NO Gala Dinner: (additional) YES/NO

VIP Welcome Reception(inc: full comp registration only): YES/NO

Additional Staff Names (2) [For office use only] Reg No AOC2012/……..…

Title: First name: Surname:

Organisation: Position

(as you wish it to appear on your namebadge)

Address: City:

State: Postcode: Country:

Mobile: Fax: Email:

Please circle registration type: Comp Full Registration/Comp Trade Pass/ Exhibitor Day Pass / Other Registration Type (Day registrations only: Circle day/s attending @ $75 per day: Monday Tuesday

Social Functions: Networking Reception(inc: full comp registration only): YES/NO Gala Dinner: (additional) YES/NO

VIP Welcome Reception(inc: full comp registration only): YES/NO

Additional Staff Names (3) [For office use only] Reg No AOC2012/……..…

Title: First name: Surname:

Organisation: Position

(as you wish it to appear on your namebadge)

Address: City:

State: Postcode: Country:

Mobile: Fax: Email:

Please circle registration type: Comp Full Registration/Comp Trade Pass/ Exhibitor Day Pass / Other Registration Type (Day registrations only: Circle day/s attending @ $75 per day: Monday Tuesday

Social Functions: Networking Reception(inc: full comp registration only): YES/NO Gala Dinner: (additional) YES/NO

VIP Welcome Reception(inc: full comp registration only): YES/NO

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Additional Staff Names (4) [For office use only] Reg No AOC2012/……..…

Title: First name: Surname:

Organisation: Position

(as you wish it to appear on your namebadge)

Address: City:

State: Postcode: Country:

Mobile: Fax: Email:

Please circle registration type: Comp Full Registration/Comp Trade Pass/ Exhibitor Day Pass / Other Registration Type (Day registrations only: Circle day/s attending @ $75 per day: Monday Tuesday

Social Functions: Networking Reception(inc: full comp exhibitor registration only): YES/NO Gala Dinner: (additional) YES/NO

Additional Staff Names (5) [For office use only] Reg No AOC2012/……..…

Title: First name: Surname:

Organisation: Position

(as you wish it to appear on your namebadge)

Address: City:

State: Postcode: Country:

Mobile: Fax: Email:

Please circle registration type: Comp Full Registration/Comp Trade Pass/ Exhibitor Day Pass / Other Registration Type (Day registrations only: Circle day/s attending @ $75 per day: Monday Tuesday

Social Functions: Networking Reception(inc: full comp exhibitor registration only): YES/NO Gala Dinner: (additional) YES/NO

Additional Staff Names (6) [For office use only] Reg No AOC2012/……..…

Title: First name: Surname:

Organisation: Position

(as you wish it to appear on your namebadge)

Address: City:

State: Postcode: Country:

Mobile: Fax: Email:

Please circle registration type: Comp Full Registration/Comp Trade Pass/ Exhibitor Day Pass / Other Registration Type (Day registrations only: Circle day/s attending @ $75 per day: Monday Tuesday

Social Functions: Networking Reception(inc: full comp exhibitor registration only): YES/NO Gala Dinner: (additional) YES/NO

Additional Staff Names (7) [For office use only] Reg No AOC2012/……..…

Title: First name: Surname:

Organisation: Position

(as you wish it to appear on your namebadge)

Address: City:

State: Postcode: Country:

Mobile: Fax: Email:

Please circle registration type: Comp Full Registration/Comp Trade Pass/ Exhibitor Day Pass / Other Registration Type (Day registrations only: Circle day/s attending @ $75 per day: Monday Tuesday

Social Functions: Networking Reception(inc: full comp exhibitor registration only): YES/NO Gala Dinner: (additional) YES/NO

Please photocopy this form for additional exhibitor registrations

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ACCOMMODATION

NB No accommodation bookings will be accepted by the Secretariat after Monday 12 March 2012.

Please indicate accommodation preferences for all attendees requiring accommodation & total number of rooms required below:

Single Double Twin A$

Hilton Adelaide Hotel [ ] A$185 [ ] A$185 [ ] A$185 ……..

Total number of rooms required:

Please provide details of each attendee requiring accommodation below.

Surname: ……………… First Name:………………… Arrival Date: …/04/2012 Departure Date: …/04/2012 No. Nights

I will be sharing my room with:

Surname: ……………… First Name:………………… Arrival Date: …/04/2012 Departure Date: …/04/2012 No. Nights

I will be sharing my room with:

Surname: ……………… First Name:………………… Arrival Date: …/04/2012 Departure Date: …/04/2012 No. Nights

I will be sharing my room with:

Surname: ……………… First Name:………………… Arrival Date: …/04/2012 Departure Date: …/04/2012 No. Nights

I will be sharing my room with:

Surname: ……………… First Name:………………… Arrival Date: …/04/2012 Departure Date: …/04/2012 No. Nights

I will be sharing my room with:

If you wish to guarantee your accommodation reservation by credit card, please give details in the Payment Section overleaf. Your hotel will debit your card once you check in or if you fail to arrive on the nominated check in date. Please note that the hotel will provide a tax invoice for the total amount payable on departure.

Total accommodation deposit due: A$…………

SOCIAL PROGRAM TICKETS

No. persons A$

Networking Reception (Monday 16/04) Additional tickets ………@ A$50 A$…….

Convention Gala Dinner (Monday 16/04) Tickets ………@ A$150 A$…….

Social Program Subtotal A$…….

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EW & IO Convention 2012:

Exhibitor Registration Form (continued)

TOTAL PAYMENT DUE

Additional Exhibitors Fees A$…………..

Accommodation Deposit– 1 night minimum or credit card details as guarantee A$…………..

Social Program A$…………..

TOTAL DUE A$…………..

Australia has a Federal Goods and Services Tax (GST) of 10%.

Overseas delegates are not exempt from paying this tax. All costs include GST

All payments must be made in AUSTRALIAN DOLLARS only. Payment in any other currency will not be accepted.

Forms will not be processed nor acknowledgements sent until payment is received.


PAYMENT OPTIONS

Option A I ENCLOSE A CHEQUE OR BANK DRAFT DRAWN ON AN AUSTRALIAN BANK (in Australian Dollars)

made payable to AOC Exhibition / Symposium

Option B I HAVE SENT MY PAYMENT BY ELECTRONIC FUNDS TRANSFER TO

BANK SA, St Peters Branch, SA BSB: 105 034 Account: 5994 1540

Account Name: AOC Exhibition / Symposium

Name of your Bank ______Date of Transfer ______

Amount Transferred ______Transfer reference ______

Please include company name / delegate name &/or invoice number on the transfer details and fax/email remittance advice to the secretariat. Acknowledgement cannot be sent unless these details are provided.

Option C PLEASE CHARGE MY CREDIT CARD (Circle type and complete details below)

[ ] Registration Fee/Social Program

Accommodation:

[ ] YES, I would like the Convention Secretariat to charge my credit card for accommodation amount as advised on page 4.

OR

[ ] YES, I agree to my credit card details being forwarded to my chosen hotel to guarantee my reservation.*

*I understand that nothing will be debited from my credit card for accommodation by the Convention Secretariat.

Visa Mastercard NB: Amex and Diners Club cards not accepted

Credit Card Number 5555 5555 5555 5555

Cardholder's Name:

Home Address:

Credit Card Expiry Date: Signature: Date: Surname:

Australian EW, IO & Cyber Convention 2012 Secretariat

PO Box 949

KENT TOWN SA 5071

AUSTRALIA

Ph: 08 8363 1307 (Within Australia) Fax: 08 8363 1604 (Within Australia)

Ph: +61 8 8363 1307 (International) Fax: +61 8 8363 1604 (International)

E-mail:

Website: http://www.oldcrows.org.au/

We suggest you make a copy of this form for your own records. If payment has to be processed through a large organisation

and may be delayed, please forward a separate copy of the registration form to the Secretariat.

However, registrations will only be acknowledged once payment has been received.

For Office Use Only:

Reg No: AOC2012: Cheque No:

Bank: Amount: $:

Branch: Ref No::

Account No:

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