REGISTRATION FORM SIDRA INTERSECTION WORKSHOPS PERTH, 14-17 NOVEMBER 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 #TA075 Page 1 of 5
DELEGATE DETAILS Delegate 1 Delegate 2 Delegate 3 Delegate 4 If more than four delegates, please use a copy of this page. REGISTRATION FORM #TA075 Page 2 of 5
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 14-15 Nov 2017 $1,815 $1,980 $ Advanced 16-17 Nov 2017 $1,925 $2,090 $ COMBINED WORKSHOPS Intermediate & Advanced 14-17 Nov 2017 $3,465 $3,740 $ ALL PRICES are in AUD and are GST-INCLUSIVE REGISTRATION FORM #TA075 Page 3 of 5
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: 033 054 Account Number: 252845 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: http://www.sidrasolutions.com/training REGISTRATION FORM #TA075 Page 4 of 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 EMAIL 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) 9857 7462 International: +61 3 9857 7462 1) Please ensure your fax machine does NOT have a bar against international calls. 2) Dial your international access code, then dial +61 3 9857 7462 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. http://www.sidrasolutions.com/store/forms/remittanceadviceform REGISTRATION FORM #TA075 Page 5 of 5