Group Booking Delegate Registration Form

PERSONAL DETAILS
Name * Title First Last Suffix
Organisation *
Position *
PO Box or Street address *
Town/City *
State *
Postcode *
Phone Number *
Mobile Phone Number
Email *
PERSONAL DETAILS
Name * Title First Last Suffix
Organisation *
Position *
PO Box or Street address *
Town/City *
State *
Postcode *
Phone Number *
Mobile Phone Number
Email *
PERSONAL DETAILS
Name * Title First Last Suffix
Organisation *
Position *
PO Box or Street address *
Town/City *
State *
Postcode *
Phone Number *
Mobile Phone Number
Email *
CONFERENCE REGISTRATION FEE (PLEASE TICK)
Two day conference with dinner included. *
Group fee - $464 per person (GST inclusive) Additional guest to dinner - $170 (GST inclusive)
Name of guest
Total Amount * $ Dollars . Cents
SPECIAL REQUIREMENTS

Please advise of any special requirements (dietary, access etc) so that appropriate arrangements can be made.
PAYMENT
Payment Options (please tick): *
Credit Card EFT Cheque
Credit Card
Mastercard Visa
Name of cardholder
Credit card number
Expiry date
CCV code (last three digits on back of card)
EFT

Account name: National Australia Day Council
BSB: 062901 / Account Number: 10055502
Payment Descriptor: Please write your full name.
Cheque:

Make payable to the National Australia Day Council
ACCOMMODATION

Rydges Capital Hill, Burbury Hotel and The Brassey Hotel are within a short distance of Old Parliament House and the National Press Club. Preferential rates are available at the hotels. Delegates are requested to make their own reservations directly. Details and instructions are below. Please note breakfast is not included in this rate.

Please quote the code below to secure the conference rate.
Rydges Capital Hill - Superior Room $199

Cnr Canberra Ave & National Circuit, Forrest ACT 2603
T: 02 62953144
F: 02 62953325
E: reservations_capitalhill@rydges.com
Quote booking code: 1206AUS
Burbury Hotel - Burbury Room $255

Burbury Close, Barton ACT 2600
T: 02 61732700
F: 02 61732799
E: reservations@burburyhotel.com.au
Quote booking code: 1206AD
The Brassey of Canberra - Garden Room $190;
Heritage Room $211 (both include breakfast)

Belmore Gdns & Macquarie St, Barton ACT 2600
T: 02 62733766
F: 02 62732791
E: info@brassey.net.au
Quote booking code: #257002
Your registration will be confirmed by email. Cancellations received prior to 6 June 2013 will incur a fee of 10% of the registration cost. No refunds will be made for cancellations made after 6 June 2013. All figures are inclusive of GST. Please note, your registration form acts as a tax invoice.

* For information on the National Australia Day Council privacy policy please visit www.australiaday.org.au
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PERSONAL DETAILS

PERSONAL DETAILS

PERSONAL DETAILS

CONFERENCE REGISTRATION FEE (PLEASE TICK)

PAYMENT

EFT

Cheque:

ACCOMMODATION

Rydges Capital Hill - Superior Room $199

Burbury Hotel - Burbury Room $255

The Brassey of Canberra - Garden Room $190; Heritage Room $211 (both include breakfast)

The Brassey of Canberra - Garden Room $190;
Heritage Room $211 (both include breakfast)