Manual Registration Form

Transcription

1 TAX INVOICE/RECEIPT ABN: Please this form to or register online at to receive a $20.00 discount off the registration fee Manual Registration Form Personal Details Title: First Name: Last Name: Organisation: Position: Address: City: State: Postcode: Country: Phone: Mobile: Address: Dietary & Special Requirements Please inform us of any dietary requirements (e.g. vegetarian, halal, gluten free), or other special requirements (e.g. wheel chair access, vision impaired, hearing loop), you may have. Delegate List Consent In registering for the conference, your name, organisation, state/country and address will be incorporated into a conference delegate list and made available to parties directly related to the conference, including sponsors and exhibitors. Please do not include my details in the delegate list Membership Please indicate your membership. CCAA Member IQA Member Please provide your membership number 1

2 Early Bird Registrations (UNTIL TUESDAY, 16 AUGUST 2016) Early Bird Member $1, Early Bird Non Member $1, Standard Registrations (UNTIL TUESDAY, 11 OCTOBER 2016) Standard Member $1, Standard Non Member $1, Day Registrations PLEASE INDICATE WHICH DAY YOU WILL BE ATTENDING (ONE OPTION ONLY) Thursday, 27 October 2016 Friday, 28 October 2016 $ Student Registrations Student Registration $ Industry Innovation Day (ONLY APPLICABLE FOR WEDNESDAY, 26 OCTOBER 2016) Industry Innovation Day Registration $ Accompanying person Early Bird Accompanying Persons $ Standard Accompanying Persons $ Name of accompanying person address 2

3 Social Functions The Welcome Reception, Gala Dinner and Business Leaders Lunch Forum are included in full conference and accompanying person registrations. While tickets are included, they are not automatically allocated so please indicate if you will be attending. FUNCTION NAME Full / Accompanying Person Registrations Day & Student Registrations / Additional Tickets TOTAL $ Attending Cost Quantity Cost Hitachi Welcome Reception Date: Wednesday, 26 October 2016 Time: 6:00pm 9:00pm Venue: Rivers Edge Events Siddeley Street Melbourne VIC 3000 Dress Code: Smart Casual included $ Komatsu Gala Dinner Date: Thursday, 27 October 2016 Time: 7:00pm 11:00pm Venue: National Gallery of Victoria 180 St Kilda Road Melbourne VIC 3000 Dress Code: Cocktail included $ Caterpillar Business Leaders Lunch Form Date: Friday, 28 October 2016 Time: 1:00pm 3:00pm Venue: Plenary 2 Melbourne Convention and Exhibition Centre 1 Convention Centre Wharf Melbourne VIC 3000 Dress Code: Smart Casual included Ticket $ Table of 10 $1, Registration Payment Summery Conference Registration $ Social Functions $ Manual Processing fee $20.00 Late Registration Fee add $50.00 if registering after Tuesday, 11 October 2016 $ REGISTRATION TOTAL (includes 10% GST) $ 3

4 Payment Details Cheque Please send a cheque made payable to CMIC16 with a completed registration form or invoice number. Please address to: CMIC16 Conference Secretariat c/- International Conferences & Events (ICE) Pty Ltd 183 Albion Street Surry Hills, NSW, 2010 Australia Electronic Funds Transfer (EFT) Please include your invoice number when submitting an EFT payment and registration@cmic.com.au the remittance advice. Bank Name: National Australia Bank Account Name: CMIC16 BSB Number: Account Number: Swift Code: NATAAU3303M Credit Card Please debit my credit card with the amount owing on this form The conference only accepts Visa and MasterCard. Credit card payments will appear on your statement as International Conferences & Events (ICE) Aust. MasterCard Visa Card Number: Expiry Date: CVV: Cardholder Name: Cardholder Signature: 4

5 Accommodation For further details on each accommodation option please visit conference website. ADINA HOTEL MELBOURNE, NORTHBANK 550 Flinders Street, Melbourne VIC minute walk to the conference venue Breakfast $20.00 per person per day Parking $30.00 per car per day, subject to availability Internet 100MB complimentary for up to 4 devices. Guests can purchase unlimited internet for $9.95 for up to 4 devices *Special event surcharge $ on Saturday, 29 October 2016 One Bedroom Apartment 1 x Queen Bed. 2 x Single Beds on request $215.00* per night Two Bedroom Apartment 2 x Queen Beds. 4 x Single Beds on request $335.00* per night BEST WESTERN RIVERSIDE APARTMENTS ½ 474 Flinders Street, Melbourne VIC minute walk to the conference venue Check out 10:30am Parking $35.00 per car per day Internet Free Wi-Fi included in rate *Special event surcharge $ on Saturday, 29 October 2016 Early Bird Standard One Bedroom Annex 1 x Queen Bed or 2 x Single Beds Oct $ per night *Oct $ per night Oct $ per night *Oct $ per night One Bedroom 1 x Queen Bed or 2 x Single Beds Oct $ per night *Oct $ per night Oct $ per night *Oct $ per night Two Bedroom 2 x Queen Beds + 2 x Single Beds Oct $ per night *Oct $ per night Oct $ per night *Oct $ per night 5

6 CROWN METROPOL 8 Whiteman Street, Southbank VIC minute walk to the conference venue Breakfast $38.50 per person per day Parking Valet parking $55.00 per car per day Internet Complimentary Wi-Fi ideal for general internet browsing, and checking s. A premium service is available for $15.95 per day *Special event surcharge $50.00 on Saturday, 29 October 2016 Luxe Room 1 x King Bed or 2 x Twin Beds $305.00* per night CROWN PROMENADE ½ 8 Whiteman Street, Southbank VIC minute walk to the conference venue Breakfast $33.00 per person per day Parking $35.00 per car per day Internet Complimentary Wi-Fi ideal for general internet browsing, and checking s. A premium service is available for $15.95 per day *Special event surcharge $50.00 on Saturday, 29 October 2016 due to Derby Day Standard Room 1 x King Bed $290.00* per night CROWNE PLAZA MELBOURNE 1 5 Spencer Street, Melbourne VIC minute walk to the conference venue Breakfast $25.00 per person per day Parking Valet parking $35.00 per car per day Self-parking $17.00 per car per day Internet Wi-Fi included in rate *Special event surcharge $ on Saturday, 29 October 2016 Standard Room 1 x King Bed or 2 x Twin Beds $265.00* per night 6

7 Arrival Date: Departure Date: Total Nights: Estimated Arrival Time: Estimated Departure Time: Sharing With (if applicable): Special Requests (i.e.: additional bed, buffet breakfast): Credit Card Details For Accommodation Booking Credit card details are required to secure your booking. These details will officially confirm your booking. Each guest is responsible for settling their own account upon check-out. MasterCard Visa Card Number: Expiry Date: CVV: Cardholder Name: Cardholder Signature: Terms & Conditions I confirm I have read and understood the terms and conditions of my registration I confirm I have read and understood the terms and conditions of my accommodation 7