ASCILITE 98 CONFERENCE REGISTRATION FORM

Post/Fax to:
ASCILITE98 Secretariat
CEDIR
University of Wollongong  NSW  2522
Fax:(02) 42 258312

Surname
First Name Title
Organisation
Address State Postcode
Telephone Facsimile
Email address
Special Requirements (dietary, disability etc)

Please circle the appropriate responses below:
I intend to submit an abstract: Yes / No
I require bed & breakfast at Hall of Residence for $55 per night: Yes / No
Date in: ______________ Date out: ______________
Please send Motel information: Yes / No
I would like to join ASCILITE ($50) Yes / No
Registration (includes all lunches and conference dinner):
By Sep 30, 1998ASCILITE member ($335) __________
Non-member ($400) __________
Student ($180) __________
Day ($120) __________
After Sep 30, 1998 ASCILITE member ($385) __________
Non-member ($450) __________
Day ($140) __________
ASCILITE membership ($50) __________
ASCILITE Student membership ($20) __________
Additional Conference Dinner tickets ($65) __________
Accomodation ($55 per night) __________
Total Amount: __________





Payment Details

Cheque enclosed Yes/No for $__________________ payable to ASCILITE98 or please charge my :

BANKCARD ..................MASTERCARD....................VISA..........................
American Express not accepted


Amount $...........................

CARD DETAILS

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Cardholder's name: __________________________________________

Expiry Date: ______________________________

Signature_________________________________