2010 ASEPA/AASE National Conference

2010 ASEPA/AASE National Conference GEMS Pty Ltd ABN - 29 058 592 957 To register for this ASEPA/AASE National Conference please complete and submit the below registration form. Upon receipt of your registration, you will receive an electronic confirmation within five (5) working days.
A: Delegate Information
Please complete the information below:
Title	First Name	Last Name

Organisation	Position

Address	Suburb

State	Postcode

Phone Number	Fax Number	Mobile Number

Email

Confirm Email

Professional Category		Other (please specify)

Name on Badge

Gender

Emergency Contact Details
Emergency Contact Name	Emergency Contact Number

B: Registration Information

All prices on this form are in Australian dollars and are inclusive of Goods & Services Tax (GST) and Early Bird registration rates apply until the 30th of March, 2010 .

Two Day Conference Registration (Early Bird Rates)

Two Day Conference Registration Includes Pre Conference Welcome on Wednesday, 16th June and Conference Sessions on Thursday 17th, June and Friday, 18th June

AASE/ASEPA Member

$490

AASE/ASEPA Non Member

$540

Full Time Student

$300

Yes, I will be attending the Pre Conference Welcome on Wednesday, 16th June

One Day Conference Registration - Thursday, 17th June

AASE/ASEPA Member

$270

AASE/ASEPA Non Member

$290

Full Time Student

$150

One Day Conference Registration - Friday, 18th June

AASE/ASEPA Member

$270

AASE/ASEPA Non Member

$290

Full Time Student

$150

Expressions Of Interest

The 2010 Conference Committee is planning to arrange a school visit (of two local schools) on the morning of Wednesday, 16th June preceding the Conference. Please indicate if you would be interested in participating. This tour will be free of charge to all delegates.

Yes, I would be interested in attending an organised school visit on Wednesday, 16th June.

No, I am not interested in attending an organised school visit on Wednesday, 16th June.

C: Social Program

Pre Conference Welcome

The Pre Conference Welcome will be held on Wednesday, 16th June at Crocosaurus Cove, Mitchell Street, Darwin from 6pm - 9pm.

The cost of this function is included in all Two Day Registrations only.

If you are a day delegate or if you would like to purchase additional tickets for the Pre Conference Welcome please indicate the number of additional tickets you would like to purchase below:

Pre Conference Welcome Tickets: x $75

Name(s) for Additional Ticket(s):

Conference Dinner

The Conference Dinner will be held in the Waterfront Room, Level 2 at the Darwin Convention Centre, on Friday, 18th June.

The cost of attendance at the dinner is $110 per person which includes all food and beverage throughout the evening. This cost is not included in the conference registration fee and tickets must be booked by all delegates wishing to attend. Please indicate below the number of tickets you would like to purchase for the dinner.
Conference Dinner Tickets: x $110.00

Name(s) for Additional Ticket(s):

D: Special Requirements

Every attempt will be made to meet these requirements, however this may not be possible in every case.

Dietary Requirements:

Please list your special dietary requirements:

Other Requirements including Disabled Access:

Please list your other special requirements:

E: Accommodation Information

Special accommodation rates have been negotiated with two hotels in close proximity of the Darwin Convention Centre. In order to qualify for these rates, the bookings must be made through the conference organisers.

Please note that while the conference organisers will make accommodation bookings on your behalf, all payments must be made directly to the hotel on checkout unless prior arrangements have been made between the delegate and the hotel prior to arrival.

I do not require accommodation to be booked

Holiday Inn Esplanade Hotel Darwin

Esplanade Single Room at $279 per night including one (1) full buffet breakfast
Esplanade Double/ Twin Room at $299 per night including two (2) full breakfasts

Please provide the name of the person who will be sharing the room:

Please note: For bookings made at the Holiday Inn Esplanade Hotel Darwin, all accounts are to be settled by the guest upon check-out. All cancellations made 60 days before the arrival date will be subject to a cancellation fee equivalent to the total accommodation charge.

Crowne Plaza Hotel Darwin

Crowne Plaza Single Room at $309 per night including one (1) full buffet breakfast
Crowne Plaza Double/ Twin Room at $329 per night including two (2) full breakfasts

Please provide the name of the person who will be sharing the room:

Please note: Please note: For bookings made at the Crowne Plaza Hotel Darwin, all accounts are to be settled by the guest upon check-out. All cancellations made 60 days before the arrival date will be subject to a cancellation fee equivalent to the total accommodation charge.

Please enter the number of accommodation nights required:

Arrival Date
/ JUN / 2010

Arrival Flight/Time

Departure Date
/ JUN / 2010

Departure Flight/Time

F: Accommodation Authorisation Details
In order for a booking to be confirmed by the hotel a credit card number will need to be provided. Note: The hotel is not authorised to charge anything to this card unless you cancel or no show your booking and ONLY guarantees that the booking will be held by the hotel.
VISA Mastercard AMEX
Card Holder's Name	Card Number	Expiry Date /
Do you wish to use the the card details entered above for your conference payment?
Cancellations Cancellations received in writing by the Conference Organisers by Friday, 14th May 2010 will be accepted and all fees refunded less an AUD$110 administration fee. Cancellations received after this date cannot be accepted and will not be refunded; however, transfer of your registration to another person is acceptable. The full name and address details of the new delegate must be advised in writing to the Conference Organisers prior to the Conference. No refunds will be made for non-attendance at the conference.

Enter Security Code as seen above:

I have read and agree to the cancellation terms and conditions.