Complementary Registration

First Name*
Last Name
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home telephone
Mobile phone*
What is your Cultural Background?
Other organisation
Station
Program name
Program language
Day/Time/Duration of your program e.g. Mondays, weekly
2017 Registration Fees
2017 Conference Dinner*
- Attending - $65.00
- Not Attending
NB: No alcohol included in this price *
Dietary Requirement
- Vegetarian
- Vegan
- Halal
- Gluten Free
- Dairy Free
Other, please specify
Will you be attending the AGM?*
- Yes
- No
Total
$ 0.00
NOTICE OF CANCELLATION
In the event that you require to cancel your attendance at the NEMBC 2017 Annual Conference in Canberra, please note that any cancellation received on or before November 13 will receive a refund of registration less an administration charge of $50.00. Cancellation after this date will not be refunded.”
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2017 Registration Fees