ICR 2017 Conference Registration Form

My personal details are:

First Name
Surname (Mr/Mrs/Ms/Dr)
Postal Address:
Phone:
Email:

I am a member: Yes No

I want to purchase the:

Full Package: US$

Buddy Special: US$

Day Package (per day): US$

Day package: 20th Day package: 21st

Buddy Name:

My meal choice is:

Non-Vegetarian
Vegetarian
Other:

My event choices are:

I would like to attend the tour to Fr Josef's Organisation on Thursday 19th October.
(Included in the conference fee. No last minute bookings will be taken on the day.)

I would like to attend the Welcome Function on Thursday 19th October.
(Included in the conference fee)

I would like to attend the Gala Dinner on Saturday 21st October.
(Included in the conference fee)

I would also like to purchase:

A Conference Transcript (Hard Copy): US$

A Conference Photo CD: US$

A Vendor Table: US$130 for the three days
I would like to share my vendor table with:

I would like to bring guests on the tour to Fr Josef's Organisation
(US$10 per person):

I would like to bring guest(s).
Their name(s) are:

I would like to bring guests to the Welcome Function
(US$30 per person):

I would like to bring guest(s).
Their name(s) are:
Their meal requirements are:

I would like to bring guests to the Gala Dinner
(US$65 per person):

I would like to bring guest(s).
Their name(s) are:
Their meal requirements are:

I would like conference meals (Teas/Lunches for the 20th, 21st and 22nd October)
(US$65 per person):

I would like meals for guest(s).
Their name(s) are:
Their meal requirements are:

Conference package total: US$
Optional extras total: US$

Grand total: US$

Your reference is: