Register & Pay By Cheque

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Payment enquiries:
Contact Conference Treasurer
Geoff Caddy
Phone 03 5243 6977
Email: treasurer@rotaryhightonkardinia.com.au

Registration enquiries including difficulties & faults with the registration process:
Contact
Geoff Leigh
Phone 0433 579 335
Email: g.leigh@rotaryhightonkardinia.com.au

Other enquiries: Contact Conference Secretary
Geoff Leigh
PO Box 618
Belmont 3216
Phone 0433 579 335
Email: g.leigh@rotaryhightonkardinia.com.au

To register and pay by Cheque

Complete the registration form below.
Print the form and check the details.
If all is correct click on submit, then post your printed form and cheque to:

Rotary District 9780 Conference 2010 Registration
Po Box 768
Belmont
VIC 3216

A confirmation email will be sent to you within 3 working days of receival of your registration details. If you do not receive this email please contact the Secretary immediately.

Fields denoted with an asterick (*) are compulsory

1. Complete this registration form below

Rotarian

Surname *
First Name *
Badge Name
Dietary or Other Special Requirements
Phone Work
Phone Home *
Phone Mobile
Email *
Address *
Suburb/Town *
Postcode *
Rotary Club *
Rotary Title
Will you be accompanied to this event? YesNo

Accompanying Person / Rotarian

Surname
(Please supply if you you are to be accompanied)
First Name
(Please supply if you you are to be accompanied)
Badge Name
(Not required if not a Rotarian)
Dietary or Other Special Requirements
Phone Work
Phone Home
Phone Mobile
Email
Address
Suburb/Town
Postcode
Your Rotary Club if a Rotarian
(or Rotarian's Club as above)
Rotary Title

Conference Costs (including GST)

	Rotarian	Accompanying Person
All Conference Sessions Including Saturday Dinner & Entertainment $185.00 per person
All Conference Sessions Excluding Saturday Dinner & Entertainment $140.00 each person
Friday Only $40.00 per person
All Saturday Sessions Including Breakfast, Dinner & Entertainment $160.00 per person
Saturday Dinner & Entertainment Only $60.00 per person
Sunday Sessions Including Lunch $35.00 per person
As Add On To Any Item Above: Sunday Breakfast With RI Representative $15.00 per person
Total	$

I would like to be sent a tax invoice once this payment is processed Yes

2. Print the form and check the details.

Before you submit this registration form, you must first print this form. To print this form simply click on the printer icon. If you change any of your registrations details after printing, you will need to print off another copy of this form.

3. If all is correct click on submit, then post your printed form and cheque to:

Rotary District 9780 Conference 2010 Registration
Po Box 768
Belmont 3216