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Personal Information
Title
First name
Surname
Indigenous Name
Preferred Name for Name Tag
Position
Email
Telephone
Mobile
Company/organisation
Address
City
Postcode
Fax
   
Registration Information
Cultural Collaborations Forum July 9 & 10 $595
Single Day Registration for the Cultural Collaborations Forum (please select day)

(Single Day Registration does not include Dinner)		 9th ($330)
10th ($330)
 
Indigenous Researchers Forum
July 11, 12 & 13		 $595
Single Day Registration for the Indigenous Researchers Forum (please select day)

(Single Day Registration does not include Dinner)		 11th ($330)
12th ($330)
13th ($330)
Combined full registration
Combined full registration $1012
   
Student discount
If you’re a full time post-graduate student, please enter your Student Number  ( valid student no.)

Please tick here to receive a 10% discount to your registration 

 
Total   $

Other functions:
Do you have any special dietary requirements that we need to be aware of? Yes No
If yes, please select
Other (please specify)
If attending the Cultural Collaborations Forum, will you be attending the welcoming ceremony (which is included in your Registration Fee) Yes No
If attending the Cultural Collaborations forum will you be attending the Forum dinner which is included in your Registration Fee? Yes No
Do you wish to arrange tickets at $75 for friends or family to attend the dinner? Yes No
If yes, how many? 
If attending the Indigenous Researchers forum will you be attending the Forum dinner which is included in your Registration Fee?
 Yes No
Do you wish to arrange tickets at $75 for friends or family to attend the dinner? Yes No
If yes, how many?
   
Your total registration fee is $
   
How do you wish to pay for your registration?
   
By Cheque
By Direct Debit
By phone Credit Card payment
By secure online credit card payment (in which case you will proceed to our secure payment gateway as soon as you Submit this registration).
   
You will receive an automatic email to confirm that we have received your Registration.  A Tax Invoice/Receipt will be posted to you within the next few days.
   
Your registration above constitutes a booking to attend the Forum(s).  Please refer to our conditions of cancellation/transfer
   
Please tick here to indicate that you have read our Terms & Conditions. Yes
 
   
 
If you have any questions, suggestions or thoughts, please feel free to contact us on the Indigenous Researchers Forum Hotline 1300 55 32 35
or email info@regionaleventsaustralia.com