PLEASE PRINT THE COMPLETE FORM AND FAX OR MAIL
TO THE ADDRESS AT THE BOTTOM OF THE PAGE
Title: .......... Given Name: ...................................... Family Name: ....................................... Position: .............................................................................................................................. Division: .............................................................................................................................. Organisation: ....................................................................................................................... Street Line 1: ......................................................................................... Street Line 2: ......................................................................................... Suburb/Town: ........................................... Postal Code: .................. State: .......................... Country: ................................... Phone (W: .................................. Fax (W): ................................ Phone (H): .................................. Fax (H): ................................ Mobile Phone: ............................................... E-mail: ...........................................................
Please tick beside the appropriate amount/s: Exhibition Space Profit Organisation $A1000 | | Exhibition Space Nonprofit Organisation $A 500 | | Insert in satchels Profit Organisation $A 800 | | Insert in satchels Nonprofit Organisation $A 300 | | Full page advertisement in final Program $A 400 | | Half page advertisement in final Program $A 200 | | Total Payment $: ...................
Please specify stand name: .................................................................................
Stand Manager: ..................................................................................................
Power and lighting requirements: .........................................................................
Accessories: ......................................................................................................RETURN ADDRESS
Beth Stoodley
Centre for Continuing Education
The Australian National University
CANBERRA ACT 0200
AUSTRALIA