If you would like your name tag to appear in a format which is different from
John Smith (sic.), please indicate preferred name here:
Department :
Institution/University :
Address *:
* Please give an e-mail address if you have one and use it regularly.
Alternatively, you can give us a fax or telephone number or a
regular address where you can be contacted.
I am submitting a paper
Title :
I wish my contribution to be considered for a talk
Applicant for Smith-White prize
Please see notes in The program about posters and talks.
Accomodation
I request college accommodation at Wesley College ($40 per night including
breakfast) for the evenings of:
Tue July 7
Wed July 8
Thu July 9
Fri July 10
Sat July 11
Sun July 12
A limited number of rooms has been reserved at the University Motor Inn,
which is within 200 metres of the meeting site. These rooms will be assigned
in order of requests. If you are requesting rooms for sharing, please ensure
that only one of the group sharing a room submits the request. Rates are $102
for single accommodation, $106 for double, $119 for three sharing and $131
for four sharing (no meals included).
Wed July 8
Thu July 9
Fri July 10
Sat July 11
Number sharing :
(1)
(2)
(3)
(4)
Any additional request :
Payment
We have been advised that credit card information cannot be received over the internet. Please ignore the remainder of this form and request the
payment form.