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					                                                              CAMPBELLTOWN ARTS CENTRE


                                         CODING CULTURES SYMPOSIUM
                                            REGISTRATION FORM

      Event: Coding Cultures Symposium

      Date:              9 March                              Time:


REGISTRATION FEE PAYMENT:

Name:


Phone number/s:


Address:


Credit Card type:
                                                 MasterCard                     Visa                     Bank Card


Name on card:


Credit Card Number:


Expiry Date:                                                    _ _ / _ _

INFORMATION:

Full Price:
No. of Registration @                    Sub Total         =$

$      50         ea =
                             Merchant Service Fee           =$
$

Concession Price:                                TOTAL = $
No. of Registration @
                              NOTES (office use only):
$      30         ea =

$

Privacy Information:         Your details have only been provided to register for the Coding Cultures Symposium and will not be
                             passed to any other party for any other purpose.
Warning:                     The credit card slip is to be signed on registration arrival at the Symposium (identification must be
                             provided).
Refunds:                     The registration fee cannot be transferred, exchanged or refunded unless the event is cancelled.
Merchant Service Fee:        All transactions made via credit card will incur a merchant service fee of 0.83% of the cost.

				
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posted:10/15/2011
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