| Company Name |
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| Delegate Name |
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| Delegate Position |
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| Delegate Phone Number |
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| Delegate Email Address |
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| Billing Company/Contact |
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| Billing Address |
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| Country |
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| Region/State |
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| Postcode |
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Billing Contact Name
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Same as Delegate Name
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| Billing Contact Phone |
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| Billing Contact Email |
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| Registration Rate |
$A950.00 (inc of GST) on or before 6 May 2011
$A1,150.00 (inc of GST) after 6 May 2011
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Payment methods
Please check one |
Cheque
Payable to Paydirt Media Pty Ltd and marked "not negotiable"
Credit Card
Please note that a merchant fee of 3.8% applies to payments made on Amex and Diners cards.
Please call (+61 8) 9321 0355 to pay by credit card over the phone or
complete this form and fax back with your credit card details.
Bank Transfer/EFT
(please quote invoice number or company name)
PAYDIRT MEDIA PTY LTD Bank: ANZ Bank, West Perth Account: 837162319 BSB: 016-498
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| For enquiries please contact |
Lisa Millman, P.O.Box 1589, West Perth, Western Australia 6872
Tel: (+61 8) 9321 0355
Fax: (+61 8) 9321 0426
Email: lisa.millman@paydirt.com.au |
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• Normal delegate registration payment is due and payable on Friday, 3 June 2011. No refunds/ credits will be given for cancellations made after this date. However, replacement/ substitute delegates may be nominated.
• Cancellation/ substitution requests must be submitted in writing to the conference coordinator prior to the conference.
• As the event is held and hence deemed to be enjoyed in Australia, delegate fees are subject to the Goods and Services Tax (GST). |
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