Conference Registration Form and Tax Invoice by dxf10620

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									                                                                  ANU COLLEGE OF ARTS & SOCIAL SCIENCES

                                                                  Research School of Humanities and the
                                                                            Arts Conference

                In the Image of Asia: Moving across and between locations
                                                         13-15 April 2010

                        Venue: Sir Roland Wilson Building, The Australian National University

                              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/2010/imageofasia/index.php
Attendee Information & contact details:
Title:
                                                                Mailing Address:
First Name:
Surname:
Department:
                                                                State/Province:
                                                                Country:                     Postal/Zip Code:
Institution:
Email:                                                          Telephone:

Registration fees
Registration covers morning and afternoon teas and
                                                                    Early bird                      Regular
lunches. All fees are inclusive of GST. The Australian
National University — ABN 52 234 063 906                     (by 21 December 2009)            (by 10 March 2010)
Standard                                                             $210                           $250
Concessions/Students                                                 $120                           $160
Standard Day Rate                                                    $80                            $90
Concessions/Students Day Rate                                        $50                            $60
For Day Rate please circle day of attendance: Tuesday              Wednesday      Thursday
                                                                                     $40
Conference dinner (optional)
                                                                      Please circle Vegetarian or non-V
TOTAL

Payment
 Cheque (AUD$)                   The Australian National
      Payable to:                 University                            Post, Email or Fax this form with your
 Cash:                                                                              payment to this address:
 Credit Card:                                                                 Leena Messina, Programs Manager
    Visa                                                                           Research School of Humanities
                                                                                 College of Arts & Social Sciences
    Mastercard                                                                  The Australian National University
                                                                                  Sir Roland Wilson Building #120
    Bankcard                                                                              Canberra ACT, Australia
Card Number:                                                                                 T: + 61 (0)2 612 54357
Expiry Date:                                                                                 F: + 61 (0)2 612 51380
                                                                                     E:Leena.Messina@anu.edu.au
Cardholders Name:
Cancellation will incur a $20 administrative fee.
Please tick the box if you wish to go on the RSH mailing list to receive information about up-
coming conferences.

								
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