APPLICATION & FEES
APPLICATION FORM
(Please print out from web browser and return via fax or post by 23 September 2005)

Title ............................................................................................

Given Name ................................................................................

Surname .....................................................................................

Organisation ................................................................................

Address ......................................................................................

....................................................................................................

....................................................................................................

Post Code..............        

Phone ...........................................................................................

Facsimile ......................................................................................

Email .............................................................................................
 
Conference Dinner
Please indicate if you wish to attend the conference dinner on 12 October
YES        NO
Note: Places at the dinner are strictly limited to the first 100 acceptances.

REGISTRATION FEE

Conference Dinner
$65  

Early Bird
(registration received before 6 September)
$175  

Two day full rate
(registration received after 6 September)
$200  

Two day rate (students, pensioners)
$175  

Serving men and women
$150  

One day attendance flat rate
$120  

PAYMENT
  • Please make cheques payable to:
    Receiver of Public Monies Dept of Defence
    (Army History Unit)
    This may be abbreviated to RPMDoD (AHU)
  • Invoice (ADF and Australian Government Personnel only)

Or Debit (     ) Mastercard     (     ) Visa     (     Bankcard

Card No: ..................................................................................

Expiry Date:  ................./.................

Name of Card Holder: ..................................................................

Signature: ...................................................................................

Mail or fax to:

Army History Unit
CP$-2-031
Department of Defence
Canberra ACT 2600
ABN: 68 706 814 312
REFUNDS & CANCELLATIONS
Until 23 September cancellations will be fully refundable and no cancellation fee will apply. Between 24 September and 10 October a cancellation fee of 25% must be applied to cover costs already incurred. After 10 October refunds not available
Further enquiries phone: 02 6266 2744
© 2004 Dept of Defence