Name :
Department :
Organisation:
Address :
City :
Post Code:
Country :
Telephone :
Fax :
E-Mail :
Name for badge
Special dietary or other needs
ASCILITE MEMBERSHIP
I want to join ASCILITE I want to renew my membership of ASCILITE
REGISTRATION (Check one)
Non-Member Registration	$440
Member Registration	$325 - Before 30th September $390 - After 30th September
Full-time Student Registration	$150 - Member $170 - Non-member
Day Registration	$120

WORKSHOPS
Sunday AM	Presenter	Workshop	Cost $60
Sunday PM	Presenter	Workshop	Cost $60
Thursday AM	Presenter	Workshop	Cost $60

EXTRA SOCIAL FUNCTION TICKETS
Extra Conference Dinner tickets @$60
Extra Welcoming Barbecue tickets @$20
PAYMENT DETAILS
SUBTOTALS	Registration	$
	Extra Social Functions	$
	ASCILITE Membership	$
	Workshop Registration	$
	TOTAL	$
I wish to pay by credit card. Payment By: Visacard Mastercard Bankcard   Name (exactly as on card):   ............................................. Card No:   ............... - ............... - ............... - ............... Expiry Date:   ....................... Cardholder's signature :     ............................................. I enclose a cheque/money order made payable to ASCILITE '97. A refund, less an administration charge of $50, will be made on cancellation provided that it is received by 15th November 1997. Thereafter, the full amount will be forfeited.

ASCILITE '97
Computing Centre
Curtin University of Technology
GPO Box U1987, Perth
Western Australia 6845
phone (61 8) 9266 7869
fax (61 8) 9266 2673

PLEASE NOTE:

Conference details may change