REGISTRATION FORM

 Please complete this form and print it to send with your cheque (payable to Cairns Branch QAGTC Inc) to:

     Registrations
     QAGTC/ALEA Conference
     PO box 1065
     Cairns          QLD         4064

  (Payment must accompany registration and be received by 10th June 1999. There will be no refunds after that date.)

 Please register me for the 3rd Regional Conference of the QAGTC, in conjunction with ALEA,  convening on 4th and 5th July 1999.

 Name:

 Telephone Home:Work:Fax:
 E-Mail Address: 

 Mailing Address: 
 Suburb/Town: Postcode: 

 School Address:
 Suburb/Town: Postcode: 

 I would like to be registered for the following:
 
 Full Registration  $100 $ 
 QAGTC/ALEA members, speakers, groups of 10+ $ 90 $ 
 Full Time students (with copy of ID) $ 50 $ 
 Single Day               Saturday           Sunday  $ 60 $ 
Total Enclosed $