MX Association, Australasia, 2011 Conference

2011/2012 Registration

Delegate Details
	Name * (as it will appear on the Name Badge):	Company *
	Street *	Suburb /City *
	State	Country *
	Postcode	Email Address *
	Mobile Phone Number *	Work Phone Number
	Email for Invoicing / Accounts	Special Dietary Requirements
	Shirt Size (Men – XS, S, M, L, XL to 5XL; Women - 8 to 18)	* Required detail

Conference Details
Remittance Payable is in Australian Dollars
Overseas Delegates are responsible for all bank rates and exchange fees
	Full Conference Package (Delegate Only):
	Day 1 - Thursday 14th June 2012 Official Opening and Industry Related Talks:
	Day 2 - Friday 15th June 2012 Workshop & Technical Training Day:
	Day 3 - Saturday 16th June 2012 Workshop & Technical Training Day:

Partner / Guest Details
Please only fill in if your partner or a guest is attending the conference functions.
	Name of Partner (As it will appear on the Name Badge):
	Partner / Guest Annual Dinner (Thursday 14th June 2012):
	Partner / Guest Cocktail Evening (Friday 15th June 2012):
	Partner / Guest Annual Dinner and Cocktail Evening (14th & 15th June 2012):

Payment may be made by Direct Debit or by BPay
	Total Cost AUD: $
	Special Comments for Registrar (eg. Life Member, Sponsor etc):
An invoice for payment with bank deposit details will be issued upon completion of this form
This will be the only Tax Invoice issued by the Association.
Please ensure your accounts departments have these details for payment & registration
Cancellation Policy:
The Association will refund in full any registration fees paid if registration is cancelled in writing prior to 30/04/2011.
No refunds for registration cancellations after this date.
Please contact registration@mxassociation.com.au if you have any queries
Please press the Submit Button to proceed.

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