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conference registration & dinner booking form
Delegate Particulars Registration & Dinner Payment Options Submission Section	Regn only Regn / Accom Virtual Regn Group Regn A Accom / Dinner
please complete separate registration form for each person attending

Registration Includes:
- Evening Welcome Reception (Tues 16 July 2002)
- All Plenary and Parallel Sessions
- Lunches, Morning & Afternoon Teas for the 4 days of the conference (Wed 17 - Sat 20 July 2002)

Full Conference Registration: $US 450.00 per person

$US Total Registration amount

Use separate form for each person registering to attend the conference

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Conference Dinner
- The Conference Dinner is an optional extra and will be held on Friday 19 July beside the water fountains of the Friendship Hotel forecourt

Conference Dinner: $US 55.00 per person

$US Total Dinner amount

When booking dinner for additional person/s (ie, family member not attending conference)

enter number of dinner bookings here and use the box below to note name/s

NAMES

	PAY BY CHEQUE      in the amount of: $US      cheque to be made payable to: 'Common Ground Conferences' POST TO: Learning Conference 2002 PO Box K481 Haymarket NSW AUSTRALIA 2000 Conference managed by Common Ground Conferences				PAY BY CREDIT CARD I authorise the amount of $US to be processed on my credit card Card Type: (nominate card below ) Mastercard   Bankcard  Visa   Amex  Cardholder's Name Credit Card Number Expiry Date (MM/YY) Current Date (DD/MM/YY)
					Signature: __________________________ (If submitting a printed form)
	Australian Federal Goods and Services Tax: GST not applicable				Please note that submitting this form does not result in an automatic transfer of funds from your credit card account. The transaction is processed manually only after the final cost has been confirmed - an invoice will be issued and confirmation of your credit card authorisation will be sent to you.
	TO REGISTER AND PAY BY CHEQUE:				TO REGISTER AND PAY BY CREDIT CARD:
	Register electronically by completing this form & pressing the submit button. Your registration will be acknowledged by email and an invoice forwarded to facilitate your payment. Confirmation will be made upon receipt of your payment in the post.				Complete this form and press the submit button. Acknowledgment will be sent by email and confirmed in the post. Alternatively, print a copy of the completed form and fax to (+61) 02 9591 5762 or post to: Learning Conference 2002   PO Box K481 Haymarket NSW AUSTRALIA 2000.

Please complete this last section before submitting form:

FULL NAME (required):		COUNTRY: select... Australia Bangladesh Belrus Brunei Darussalam Canada Cayman Islands China Denmark Germany Greece Hong Kong Hungary Indonesia India Iran Japan Malaysia Mexico New Zealand Norway Paupua New Guinea Singapore South Africa Taiwan United Kingdom USA Other
EMAIL (required):

- Once you have checked your entries on this form and completed this section, press the <Submit> button once only. - The contents of your submission will appear in your browser window and you may print a copy for your records. - Your submission will be processed and an acknowledgement/confirmation, together with the full submission details, will be sent to you by email. - Should you need to make any changes, this may be done after you have received the email.