REGISTRATION FORM SIDRA INTERSECTION WORKSHOPS SYDNEY, SEPTEMBER Your Details. REGISTRATION FORM #TA073 Page 1 of 5

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1 REGISTRATION FORM SIDRA INTERSECTION WORKSHOPS SYDNEY, SEPTEMBER 2017 Your Details Please give the contact details of the person managing the registrations below. Provide the delegate details on the next page. Customer ID: Company/Organisation: Contact Phone: Fax: Street Address: City: Post Code: REGISTRATION FORM #TA073 Page 1 of 5

2 DELEGATE DETAILS Delegate 1 Delegate 2 Delegate 3 Delegate 4 If more than four delegates, please use a copy of this page. REGISTRATION FORM #TA073 Page 2 of 5

3 WORKSHOP SELECTION Do you have valid COVER? Yes No *To be eligible for COVER discount, your COVER (support subscription) must be current. Workshop Date Fee w/ COVER* Fee Standard No of Delegates Amount INDIVIDUAL WORKSHOPS Intermediate Sep 2017 $1,815 $1,980 $ Advanced Sep 2017 $1,925 $2,090 $ COMBINED WORKSHOPS Intermediate & Advanced Sep 2017 $3,465 $3,740 $ ALL PRICES are in AUD and are GST-INCLUSIVE REGISTRATION FORM #TA073 Page 3 of 5

4 PAYMENT OPTIONS Choose Payment Option: Direct Deposit Please ensure you deposit full Balance Due amount into the following bank details: Westpac [Branch: Greythorn] 277 Doncaster Road Greythorn, Victoria 3104, Australia BSB Number: Account Number: Account Akcelik and Associates Pty Ltd Swift Code: WPACAU2S We will process the order when the payment (AUD) is deposited in our account. IMPORTANT: The amount due is payable in full. Please ensure that any bank fees are paid to the bank separately. We take no responsibility for incorrect amounts transferred. If insufficient funds are transferred, your training registration will not be confirmed. If excess funds are transferred, no refund will be made. REMITTANCE ADVICE is required (see last page) Bank Draft/ Cheque Please make all bank cheques or drafts payable to Akcelik & Associates Pty Ltd Bank Cheques/Drafts from the Republic of South Africa must include pre-printed or stamped statement Approved for payment of cheque outside the Rand monetary area. REMITTANCE ADVICE is required (see last page) Visa MasterCard Amex Amount: Credit card number: Card expiry date: Name as it appears on card: Signature of cardholder: $ / Before sending payment, check for seat availability: REGISTRATION FORM #TA073 Page 4 of 5

5 CONFIRMATION I understand that refunds cannot be given for cancellation of registration but another delegate may be substituted. Akcelik & Associates will be notified in advance. Signature: Date: IMPORTANT Registration is not confirmed until this form is completed, signed and returned, and payment is received. PLEASE DO NOT RETURN THIS FORM BY After fully completing this form please return by Fax or Mail only (details below). A confirmation letter and receipt will be sent when the registration form is received and payment confirmed. Fax: Local (03) International: ) Please ensure your fax machine does NOT have a bar against international calls. 2) Dial your international access code, then dial Mail: Akcelik & Associates Pty Ltd Training Workshops PO Box 1075G Greythorn, Victoria 3104 AUSTRALIA REMITTANCE ADVICE If you have made payment via Direct Deposit or sent a Bank Draft/Cheque by mail, please visit our website and complete and submit our REMITTANCE ADVICE FORM including your SIDRA Invoice Number. REGISTRATION FORM #TA073 Page 5 of 5

PUBLIC ACCESS WORKSHOP - REGISTRATION FORM (Sydney) Fill in Your Company s General Contact Details

PUBLIC ACCESS WORKSHOP - REGISTRATION FORM (Sydney) Fill in Your Company s General Contact Details Deakon Deakon Pty Ltd. Level 23 HWT Tower, 40 City Road Southgate, Victoria 3006 Australia Telephone 1800 332 566 Facsimile 03 9372 8355 Website www.deakon.com.au ABN # 52 367 906 730 ACN # 115 246 967