REGISTRATION FORM

A. Delegate Details 

TITLE (Prof./Dr./Mr./Mrs./Ms.):  _____________

SURNAME:              _______________________________________________________

FIRST NAME:           _______________________________________________________

ADDRESS:              _______________________________________________________

                      _______________________________________________________

                      _______________________________________________________


TELEPHONE:            _______________________   FAX:  _______________________

EMAIL ADDRESS:        _______________________________________________________

STUDENT NUMBER        _______________________________________________________
(if applicable)

B. Registration Fee (in Australian dollars)

The registration fee covers admission to the workshop, lunch on 10 March 1999, morning and afternoon teas and one copy of the workshop proceedings.

Payment receivedon or before 26 Feb 1999after 26 Feb 1999
Full registration$760$960
Student registration$380$480

C. Payment Methods

Payment are non-refundable upon cancellation after 5th March 1999.

  1. Bank Draft/Cheque
    Only cheques or bank drafts in Australian dollars are accepted. Please make cheques or bank drafts payable to "Monash University".

  2. Credit Cards(Master/Visa/Bank cards) 

    Please charge the total amount of A$ _________________ to my 
MasterCard/Visa/Bankcard (please circle).

Full credit card number is:  ______________________________________________

Name of Cardholder:          _______________________________________________

Expiry Date:                 ______________________

Signature of Cardholder:     _______________________________________________