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
Preferred Name For Badge
City & State
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
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
METHOD OF PAYMENT
Registration fee AMOUNT (AUD)
Electronic Funds Transfer
If you are paying by this method, please notify the conference organisers by email
(email@example.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
If you pay by EFT, please ENSURE that you include the below reference code as
part of your transaction.
USYD Bank Account
174 City Road
Chippendale NSW 2006
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.
Credit card number:
3 Digit security code:
Cheque/money order (AUD only) made payable to THE UNIVERSITY OF
Please let us know if you have any special dietary or medical needs (e.g. vegetarian
meals, wheelchair access required etc).
* This form becomes a tax invoice for GST purposes and receipt upon payment.
Please complete and return to:
Post: Historiography and Antiquarianism
c/- Ms Frances Muecke
University of Sydney NSW 2006 Australia
Please note: if paying by credit card or cheque, you should print and post this form.