Surname: ___________________________________________________________________________
Title (Prof/Dr/Mr/Mrs/Ms/Miss): _______________________ Given name(s): ______________________
Address for confirmation letter: ___________________________________________________________
_________________________________________________ Postcode: __________________________
Tel: (___) ______________________________________ Fax: (___) _____________________________
Email: _______________________________________________________________________________
Preferred name for badge: _______________________________________________________________
Institution: _______________________________________ City: ________________________________
Any special dietary or other requirements (e.g. vegetarian): ______________________________________
Certificate of Attendance required: (Please circle) ANNA / RANZCOG / ACMI
THE PRICES QUOTED BELOW ARE GST INCLUSIVE.
DELEGATES WHOSE ABSTRACTS ARE ACCEPTED
AFTER THE EARLY BIRD REGISTRATION DATE,
WILL BE ABLE TO CLAIM THE EARLY FEE
|
Before |
After |
||
B. CONFERENCE REGISTRATION |
12/9/01 |
12/9/01 |
|
|
Financial member of ISPPM |
|||
|
Full Registration: |
AU$ 400.00 |
AU$ 450.00 |
AU$ _________ |
|
Day registration: please specify day(s) ______________ |
AU$ 170.00 |
AU$ 180.00 |
AU$ _________ |
|
Non-member |
|||
|
Full Registration: |
AU$ 450.00 |
AU$ 500.00 |
AU$ _________ |
|
Day registration: please specify day(s)______________ |
AU$ 180.00 |
AU$ 200.00 |
AU$ _________ |
|
Full-time student: |
AU$ 250.00 |
AU$ 300.00 |
AU$ _________ |
|
(proof of status must be supplied by Head of Dept with registration) |
|||
Welcome Reception – Thursday, November 1 (included in registration for delegates)
|
Please specify if you will be attending |
YES / NO |
|
|
Accompany persons |
No. _______ @ AU$ 47.50 each |
AU$ ________ |
|
Congress Dinner Saturday, November 3 |
No. _______ @ AU$ 85.00 each |
AU$ ________ |
Kindly note that check-In time is 2.00pm, check-out time 10.00am
Room type: Single / Double / Twin / Other___________________(specify type)
Arrival date: ___________________________ Time: _________________________________
Departure date: ________________________ Time: __________________________________
Sharing with: _________________________________________________________________
(Reservation cannot be accepted unless accompanied by one night’s tariff by way of deposit). If breakfast is required (where quoted), please include this amount in your deposit.
|
Swiss Grand Hotel |
|||
|
Single room |
AU$ 192.50 per night |
AU$ _________ |
|
|
Double room |
AU$ 192.50 per night |
AU$ _________ |
|
|
Twin Room |
AU$ 192.50 per night |
AU$ _________ |
|
|
King room |
AU$ 192.50 per night |
AU$ _________ |
|
|
Ocean View Suite |
AU$ 214.50 per night |
AU$ _________ |
|
|
F. |
TOTAL AMOUNT |
(INCLUSIVE OF GST) |
AU$ _________ |
|
NB: |
PLEASE FORWARD COMPLETED REGISTRATION FORM WITHOUT PAYMENT. |
||
|
A TAX INVOICE WILL BE ISSUED FOR PAYMENT. |
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Cheque made payable to ISPPM 2001 Congress
| Bankcard ___ | Mastercard ___ | Visa ___ |
Cardholder number: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Cardholder’s name: _________________________________________________________________
Expiry date: ____________________ Signature: _________________________________________
PLEASE SEND COMPLETED FORM TO:
ISPPM 2001 CONGRESS C/- Wyeth Clinical Meetings Service Locked Bag 5002 BAULKHAM HILLS BC NSW 2153Tel: 61 2 8850 8317 Fax: 61 2 9023 0000
ON-LINE REGISTRATIONS CAN BE MADE THROUGH: https://www.amlink.com.au/secure/isppm2001.htm
Please note accommodation bookings close October 5th 2001
ISPPM-Secretary,
A. & J. Bischoff
Friedhofweg 8, D - 69118 Heidelberg, Germany
Phone: +49 6221 892729 Fax: +49 6221 892730
E-mail: <secretary@isppm.de>
Last updated on: 2. September 2001 by
A.Bischoff