(required) indicates a compulsory field.
Title
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Position
Branch/Division
Organisation (required)
Postal address
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City
State (required) -Please Select- Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Other
Country -Please Select- Australia Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Democratic Republic of Congo Denmark Disputed Territory Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guyana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Iraq-Saudi Arabia Neutral Zone Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Occupied Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena and Dependencies Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and South Sandwich Islands South Korea Spain Spratly Islands Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu US Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United Nations Neutral Zone United States Minor Outlying Islands United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
Postcode
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Mobile number
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Special needs (dietary, access, etc.)
Preferred name for name badge
My organisation is interested in sponsoring opportunities
May we include your name on the final delegate listing?
Indicate Day/s (and options where applicable):
Sub Total (registration fees) $
Please indicate the number of tickets required for each event:
Sub Total (networking program) $
Check In 21 October 2011 22 October 2011 23 October 2011 24 October 2011 25 October 2011 26 October 2011 27 October 2011 28 October 2011
Check Out 21 October 2011 22 October 2011 23 October 2011 24 October 2011 25 October 2011 26 October 2011 27 October 2011 28 October 2011
Number of people
Sub Total (accommodation) $
If you would like to find out more about profiling or host region opportunities at SEGRA, please tick here.
Sub Total (profiling opportunities) $
Registration $
Networking $
Accommodation $
Profiling opportunities $
Total $
PLEASE NOTE: All payments must be finalised before attending the conference, unless a government purchaser.
Payment method (required) -Please Select- Government Invoice Visa (2.5% surcharge) MasterCard (2.5% surcharge) Amex (2.5% surcharge)
Selection of MasterCard, Visa or Amex will direct you to a secure payment gateway. Management Solutions (Qld) manages delegate registration and payments on behalf of SEGRA.
CANCELLATION POLICY: All cancellations must be made in writing to the Registration Officer. Cancellations made before 20 September 2011 incur a 25% penalty. There will be no refunds after this date. Substitute delegates are welcome, however the Registrations Officer must be advised in writing of any substitute delegates who will be attending. Sharing of registration with other parties is not permitted.
(required) Please select this box to indicate your acceptance of this cancellation policy.
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