Section 1: DELEGATE DETAILS


Forum: NSW Coastal Volunteers Forum 2011.
Salutation:
First Name: (Required)
Surname: (Required)
Organisation / Land Care Group:
Title:
Address 1: (Required)
Address 2:
Suburb:
Post Code:
State:
Email:
Phone: (Required)
Fax:
Mobile:
Name To Be Printed On Attendee Badge:
Special Dietary Requirements Vegetarian Other
Do you want to participate in the Exhibition ? Yes No
Do you want to travel by Coach to the Wollongong? Yes No
Nearest Regional Town
I give permission for my details to be included in the forum delegate listing and receive future email announcements


Section 2: REGISTRATION Please select the required options.


Full Registration
Daily Registration

(includes Welcome Reception, Field Trips, Daily Sessions and Forum Dinner)

Full Registration Volunteer/Community Group Member $88.00
Full Registration Standard Forum $143.00

To assist with catering please indicate if you plan to attend these functions

Welcome Reception Yes No
Forum Dinner Yes No


Day Registration Sunday February 27 $45.00
Day Registration Monday February 28 $45.00
Day Registration Tuesday March 1 $45.00

Additional Social Functions for Day Registrants only

Welcome Reception Sunday February 27 $33.00
Forum Dinner Monday February 28 $44.00



Field Trips

Field Trips are included in Forum & Day Registration on the Sunday and Monday
Please number .(1,2,3,4) your preferences these trips.

Field Trip 1 Port Kembla
Field Trip 2 Tom Thumb Lagoon
Field Trip 3 Puckeys Estate
Field Trip 4 Bellambi Dunes


Section 3: ACCOMMODATION Please select the required options.



Accommodation bookings are subject to availability, please book early.
Accommodation CANNOT BE CONFIRMED unless full payment or an authorised purchase order is received. Cancellation conditions apply.
Unless indicated, the rates are per night and do not include breakfast or incidentals.

Arrival Date ETA Departure Date
Pick a date Pick a date
dd-mm-yyyy 00:00:00 dd-mm-yyyy



FORUM ACCOMMODATION OPTIONS





No of Nights
I would like to share with or be accompanied by


FORUM ACCOMMODATION O
FORUM TOTAL

Registration Fee $
Accommodation Fee $
Total Fee $
Payment Method
Online Credit Card Transaction
Direct Debit
Mail In

Credit Card Details

Select Card Type:

Enter Card Number:

example:( 1234567890123456 )

Select Expiration Date:

example:( MM YY )


Direct Debit Details
Direct Deposit (EFT) to Bendigo Bank, Wyong
Account Name: WyCare Inc.
BSB: 633000
Account No: 124911983
Please fax remittance advice to: 02 43510254 or email: wycare@bigpond.com

Mail In Details
Cheque for payable to: WyCare Inc.
Post to P.O. Box 314, The Entrance, 2261





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