First Name*

Last Name*

Gender*

male

female

Separator

Airport*

Separator

Address 1*

Address 2

Postcode / Zip*

Town / City*

Country*

Separator

International phone number*

Email*

Separator

IACAC Status*

Active

Honorary

Retired

Guest

Religious denomination*

Dietary requirements

Separator

Booking

Please tick the boxes to indicate your requirements. Please note the Melbourne Chaplaincy team will book accommodation as requested at the Conference Centre for 2 nights preceding the conference, one night after the conference and the night after the post conference tour. The room rate will be $155 Single and $174 Double/Twin and includes a continental breakfast. These extra nights are not included in the conference fee but must be paid at the time of booking.*

IACAC Conference: Single $1100AUD; Twin Share $760AUD

Post Conf Tour: Single $990AUD; TwinShare $690 AUD

Fri, 11th October: B&B Single $155AUD; Double/Twin $174 AUD

Sat, 12th October: B&B Single $155AUD; Double/Twin $174 AUD

Fri, 18th October: B&B Single $155AUD; Double/Twin $174 AUD

Tue, 22nd October: B&B Single $155AUD; Double/Twin $174 AUD

Acommodation*

Single Room

Twin Share / Double Room

Name of person with whom you will share

Separator

Emergency Contact

Emergency contact name*

Relationship*

Phone day (full international number)*

Phone night (full international number)*

Address 1*

Address 2

Postcode / Zip*

Town / City*

Country*

Phone this number in a medical emergency*

Separator

Authorisation

I authorise any doctor or hospital to administer treatment as deemed necessary due to illness or accident. I accept all responsibility for any treatment and corresponding charges that may occur during my stay. I do not hold liable any person(s) or group(s) for any illness, accident or inconvenience that may occur during my visit. I understand I should arrange my own travel insurance, which covers medical evacuation if necessary.*

I have read and understood the above authorization and agree to it.

Separator

I understand it is my responsibility to ensure I have the appropriate visa for entry to Australia for the conference. *

I understand

Separator

I understand that I have to pay any bank charges and transfer fees that arise from paying the conference fee.*

I understand

Separator

I agree to my personal data being stored in order to process the conference registration.*

I agree

Conference Registration

Registration for the 2019 IACAC Conference and Post-Conference-Tour in Melbourne/Australia

Booking

Emergency Contact

Authorisation