Postal Address

PO Box: 1858
Townsville, Queensland 4810
Phone: (+61)7 4772 4800
Fax: (+61)7 4772 1840

Conference Convener
Dr Farvardin Daliri OAM
Email: farvardin.Daliri@bigpond.com

Conference Administrator
Shevindi De Motte
Email: shevindi@townsvilleic.com.au

Conference Registration
Email:
iuidconference@townsvilleic.com.au

When : 18-19 August 2011
Where : Rydges Southbank Townsville Hotel
Queensland, Australia

REGISTRATION FORM

Login details

Category of participation

Presenter

Sponsor

Delegate

Title*

Full Name*

Organisation*

Position*

Address for correspondence:*

City/Suburb*

State*

Postcode*

Country*

Phone*

Fax

Mobile*

Name as you wish it to appear on your name badge

Special requests

Please indicate if you will be attending the Conference Gala Dinner 7.00pm – 10.30pm, Thursday 18 August Spouses and non-conference guests are welcome to attend

Number of dinner guests

x AU$90pp

Government	$1000
Non - Government & Not for Profit Organisations	$500

Conference exhibition booth fee total AU$

TOTAL PAYMENT DUE AU$
Payment Method – Please tick appropriate box
Cheque enclosed: Cheques should be made payable to Townsville Intercultural Centre Ltd.
Direct Deposit:	Bank: Commonwealth Bank of Australia Account name: Townsville Intercultural Centre Limited (Cultural Fest)
BSB No- 064 817	Please ref - IUIDCREG
Account No. 1064 6666	Date Deposited :
CreditCard:	Mastercard Visa Card
Card Number :	- - -
Date :

Card Holder’s Name (please print):
Online Payment