Honoring the child, honoring equity 

Honoring the Child, Honoring Equity 7
CEIEC Annual Conference 2007
Registration/Payment Form 

Personal Details	
Title:		Last Name:		Given Name:		
Affiliation:
(for name badge)		
Dietary Requirements:	
	
Contact details	
Telephone:	Bus:		Mobile:		
	Home:		Fax:		
Mailing Address:
	Address:	
	
	Suburb:		Postcode:		
Email:
		
Attendance Details	
Presenter
(Please tick)  	YES	NO			
Days/Events attending: 
(Please tick)  	Thurs 15 Nov	Fri 16 Nov	Sat 17 Nov	Conference Dinner
(Fri 16 Nov)	
Registration and Payment Details	

Please tick	

	Early Bird 
before 
15th Aug 2007	

	Standard from 16th Aug
2007 	Payment Required 
(amounts include GST)	
Full Conference Registration 
Full registration is inclusive of GST & includes: teas, lunches, all conference sessions (Thursday-Saturday), & book of abstracts.		$350
		$400		
CEIEC Members Registration 
Registration is inclusive of GST & includes: teas, lunches, all conference sessions (Thursday-Saturday), & book of abstracts.		$315		$360		
Day Conference Registration (Friday or Saturday only)
Please indicate day/s of attendance above		$250		$300		
Opening Day registration (Thursday night only)
Conference opening only		$100		$150		
Student Full Conference Registration 
Full time students only – proof of full time status required with this form
Payment is inclusive of GST & includes: teas, lunches, all conference sessions, conference opening & book of abstracts.		$ 200		$250		
Student Day Conference Registration  (Friday or Saturday only)
Full time students – proof of full time status required with this form
Please indicate day/s of attendance above		$150		$200		
Conference Dinner 
16th of November – Venue to be confirmed		$65		$65 		
Total Including G.S.T. $

Payment information	

•	Full registration is inclusive of GST & includes: teas, lunches, all conference sessions, conference opening & book of abstracts.
•	Please make cheques/Money orders (in Australian dollars) payable to The University of Melbourne. 
•	All prices are inclusive of GST.
•	Late registrations will be accepted. Please email education-ceiec-conference@unimelb.edu.au 
•	Cancellation fees: to 15th September, 2007 - $50, 16th September, 2006 to 15th October, 2007 - $100. No refunds from 16th October, 2007. 
•	Students must submit Student ID card showing proof of full time study status with their payment form. A letter from your University Faculty will also be acceptable.

Payment Method	
Please tick  
Bank cheque		Money order		Master
Card		Bankcard		Visa		

Card Number:		Expiry Date:		
Card Holder’s Full Name:	
	
Card Holder’s Signature:
(Please do not email credit card details – refer fax number below)		
Amount ($AUD) including GST:	
	Date: 	DD/MM/YYYY	
The University of Melbourne ABN: 84 002 705 224

	Credit Card Debit Authority Declaration: Please deduct the relevant fee as per the payment option chosen. I understand that charges will be debited from my credit card upon receipt of this form by The University of Melbourne. Refunds will be given upon receipt of written advice withdrawing from the conference. However, a cancellation fee will apply (refer schedule above “Payment Information”). 

Payment Submission	

Please send completed registration/payment to:
CEIEC conference administrator
CEIEC, East Wing, Elisabeth Murdoch building, Parkville Campus, The Univeristy of Melbourne, Parkville 3010, Victoria  Australia

CREDIT CARD PAYMENTS MAY BE FAXED DURING BUSINESS HOURS (AUSTRALIAN EASTERN STANDARD TIME (AEST):
CEIEC CONFERENCE  Fax: +61 3 93479380

Payment Enquiries	
Payment enquiries can be directed to education-ceiec-conference@unimelb.edu.au	
Office Use Only	
DATE RECEIVED:	COMMENTS: