Conference Registration Form and Tax Invoice

							                      Research School of Humanities Conference

                      Reworking the Regency Conference
                                        8-10 October 2009
                  Venue: Gryphon Gallery, University of Melbourne

                   Conference Registration Form and Tax Invoice
                      THE CONFERENCE IS OPEN TO ALL ON PAYMENT OF REGISTRATION FEE

  To register for the conference, please print out this form, fill in the details,
  and send to the address below, with your payment. Your receipt will be issued on
arrival at the conference. For more information about the conference please -visit:
           http://rsh.anu.edu.au/events/2009/reworkingtheregency/index.php

Attendee Information                                       Registration Fees
Title:                                                     Please note that registration covers morning
                                                           and afternoon teas and lunches. All fees are
First Name:                                                inclusive of GST. The Australian National
Surname:                                                   University — ABN 52 234 063 906
Department:                                                Full Rate:                    $200.00
Institution:                                               Day Rate:                     $75.00
Mailing                                                    Concession/Students:          $120.00
Address:                                                   Day Rate:                     $45.00
                                                           NGV floor-talk        by      * $5.00
State/Province:                                            Roger Leong                   (optional)
Postal                                                                                   $80.00
Code/Zip:                                                  Dinner @                      (optional)
Country:                                                   Total:
                                                           Vegetarian Option:
Main contact:                                              (tick)
Email:
                                                           * "Persuasion: Fashion in the Age of
                                                           Jane Austen" exhibition at the National
                                                           Gallery of Victoria, with floor-talk by
Telephone:                                                 curator, Roger Leong.

Please tick the box if you wish to go                      Payment
on the RSH mailing list to receive
information about up-coming                                 Cheque (AUD$)
conferences.                                                     payable to:            ANU
Speakers A/V requirements                                   Cash:
                                                            Credit Card:
                                                                                 Visa

                                                           Mastercard

                                                           Bankcard
                                                           Card Number:
                                                           Expiry Date:
                                                           Cardholders Name:
Cancellation will incur a $20 administrative fee.
Post, Email or fax this form with your payment to this address:
Leena Messina, Programs Manager
Research School of Humanities, CASS, The Australian National University
Sir Roland Wilson Building #120, Canberra ACT, Australia
T: + 61 (0)2 612 54357
F: + 61 (0)2 612 51380
E: Leena.Messina@anu.edu.au