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					                        Registration Form and Tax Invoice*
                            The University of Sydney
                               ABN 15 211 513 464

      PLEASE RETURN REGISTRATION FORM BY 30 JUNE 2011

                        Historiography and Antiquarianism
                                12-14 August 2011

PLEASE COMPLETE CLEARLY AND IN BLOCK LETTERS


First Name(s)
Surname
Preferred Name For Badge
Institutional Affiliation
Position
Postal Address
City & State
Country
Telephone
Fax
Email Address


CONFERENCE REGISTRATION (FULL)
Includes all sessions from Friday 12 August - Sunday 14 August 2011, all morning
teas and afternoon teas, drinks on Friday, and lunches on Saturday and Sunday.
Prices given in AUD.

Cost                         Full rate $110             Concession/PG rate $85
(includes GST)

CONFERENCE REGISTRATION (single day)
If attending for a single day, please circle the date        12/8 13/8 14/8

Cost                         Full rate $38              Concession/PG rate $33
(includes GST)


METHOD OF PAYMENT

Registration fee                                            AMOUNT (AUD)
                                                            $ ____________
    Electronic Funds Transfer
If you are paying by this method, please notify the conference organisers by email
(antiqua2011@gmail.com) that the transfer has been made and the date on which
you made it so we can keep track of payments. If paying by EFT you may email this
form.
If you pay by EFT, please ENSURE that you include the below reference code as
part of your transaction.
USYD Bank Account
                             509448377
Number
                             Wentworth Building
                             174 City Road
Bank Name
                             Chippendale NSW 2006
                             Australia
BSB                          082 372
Swift Code:                  NATAAU3302S (for overseas transfers only)
Ref. code                    3201 D6802 11111 CFMUECKE


   Credit Card Payment                    Mastercard          Visa
Please ensure your card will not have expired by the time we process the form.
Cardholder’s Name:
Credit card number:
Expiry date:
3 Digit security code:
Cardholder’s Signature:

  Cheque/money order (AUD only) made payable to THE UNIVERSITY OF
SYDNEY

SPECIAL NEEDS
Please let us know if you have any special dietary or medical needs (e.g. vegetarian
meals, wheelchair access required etc).
      Dietary Needs
      Health/Medical Needs

* This form becomes a tax invoice for GST purposes and receipt upon payment.
Please complete and return to:
                         Email: antiqua2011@gmail.com
                         Post:         Historiography and Antiquarianism
                                       c/- Ms Frances Muecke
                                       SOPHI A14
                                       University of Sydney NSW 2006 Australia

Please note: if paying by credit card or cheque, you should print and post this form.

				
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