Travel and Accommodation Booking Form

• Travel and Accommodation may be booked by printing out this form, filling it in and mailing or faxing it to the address below

Name :
Department :
Organisation:
Address :
City :
Post Code:
Country :
Telephone :
Fax :
E-Mail :

Travel & accommodation details

	Ade.	Melb.	Syd.	Bris.	Dar.	Hob.	Can.	Add. night	Single supp.
Vickery House	$651	$659	$679	$809	$857	$837	$699	$45	N/A
Japan House	$691	$699	$719	$849	$897	$877	$739	$55	N/A
Rydges	$705	$815	$836	$964	$911	$891	$826	$78	$234
Ibis	$660	$770	$791	$919	$866	$846	$781	$63	$189
Terrace	$612	$722	$743	$871	$818	$798	$733	$47	$141

Travel required:

Departure date:
From:
Return date:

Accommodation required:

Vickery House
Japan House - Fully booked!

Rydges	Single
	Twin
Ibis	Single
	Twin
Terrace	Single
	Twin

I wish to share with

Special instructions (e.g. dietary, twin/dble bed, Frequent Flyer #)

Payment details

Package $ ea x = $

Add. nights $ea x = $

Single supplement $

Total for travel and accommodation $

I wish to pay by credit card.

Payment By:

Visacard
Mastercard
Bankcard
American Express
Diners Club

Lorraine Kershaw
Dianella Plaza Travel
Shop 5, Dianella Plaza Shopping Centre,
Alexander Drive, Dianella,
Western Australia, 6062

E-mail: lkershaw@Bigpond.com
Fax: +61 89 375 1157
Tel: +61 89 375 2885