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Campaign# ETGen

Ledger# 1890a

Registration Form
______________________________________________________________

Conference: Our Work Our Lives 2011

(Working Womens Centre Timor-Leste - WWCTL)
______________________________________________________________

Please return this form and payment to: Union Aid Abroad-APHEDA Level 3, 377 Sussex St, Sydney NSW 2000 Phone: 02 9264 9343 Fax: 02 9261 1118

Payment details
I am paying: Early Bird registration (by 31 July, 2011) - AU$475* Standard registration - AU$525*
*A recommended donation of AU$320 has been included in both conference registration fees. These funds will be used by WWCTL to assist with its establishment and ongoing work. A single receipt will be mailed to you by APHEDA which shows both the tax deductible (in Australia only) and non-tax deductible components. Should additional funds be made from the conference, these will also be directed to WWCTL.

Cash MasterCard

Cheque/Money Order (made out to Union Aid Abroad-APHEDA) Visa

Card Number:
(must be 16 digits)

Expiry Date: Name (exactly as on card):

/
Signature:
Or taken over phone by:

Address:
(for receipting purposes)

Daytime Phone:

Continued
Conferenceenquiries: MsJessicaSequeiraWWCTL http://workingwomenscentretimorleste.blogspot.com/ Email:wwctimor@gmail.com RegistrationEnquiries: UnionAidAbroadAPHEDA office@apheda.org.au

All information received by APHEDA will be used in accordance with our full privacy policy available at www.apheda.org.au ABN 76 425 451 089 Charity Fundraising Number CFN 12752

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Campaign# ETGen

Ledger# 1890a

Additional registration details

Preferred name for conference name tag:

Title:
Miss / Ms / Mrs / Mr / Dr / Prof / Other (please specify):

Fax #
(if applicable):

Email: Organisation
(if applicable):

Position title: Will you be attending the sunset drinks and dinner on Thursday 1st September? YES NO Please indicate any special dietary needs for the conference:

If you have a disability or require assistance to be able to participate fully in the conference, please state the type of assistance required:

Please tick this box if you do not wish to be included on the list of conference delegates
TERMS AND CONDITIONS Registration fee includes: Entrance to all conference sessions Morning teas, afternoon teas and lunches for each day of attendance Conference materials st Sunset drinks and dinner on the first evening (Thursday 1 September), including transport Transport for international delegates to and from the airport, hotels and conference venue A recommended donation of AU$320 to WWCTL. Cancellation and Substitution Policy Registrations are fully transferable. You may nominate a substitute delegate at no additional charge up to 14 days prior to the conference. Where 30 days or more written notice of cancellation (by e-mail to wwctimor@gmail.com) is received by WWCTL, a refund of all monies received less an administration charge of AU$100 shall apply. Thereafter, no refund is available. Privacy Notice - Conference registration In registering for this conference, relevant details may be incorporated into a delegate list for the benefit of all delegates (name, organisation and state). Other relevant details may be available to parties directly related to the conference including APHEDA, WWCTL, venues and accommodation providers (for the purpose of room bookings and conference options). Our Work Our Lives 2011 Sponsors will be supplied with the full name, title, organisation, state and email addresses of those delegates who do not opt out. Please tick this box if you do not wish for your details to be passed on for any of the above purposes. Image Release In registering for this conference, delegates grant permission to WWCTL, its agents and others working under its authority, to take and to have full and free use of video/photographs containing their image/likeness. It is understood these images may be used for promotional, news, on-line/multimedia, research and/or educational purposes by and for WWCTL. Should a delegate not agree to the above image release, they must advise WWCTL by emailing wwctimor@gmail.com
All information received by APHEDA will be used in accordance with our full privacy policy available at www.apheda.org.au ABN 76 425 451 089 Charity Fundraising Number CFN 12752