SECURE CREDIT CARD TRANSACTION

Payment Form

If you DO NOT wish to pay by credit card on-line:

Print a PD Event Registration form and Post/Fax, click here

or print a Membership Registration form and Post/Fax, click here

ABN: 53 175 531 577 

You are paying for (please choose one):

 

PD Event

                     

      and/or

 

2006-2007 Membership

 

Member and Delegate Details

 Family Name    
 Given Name
 Company
 Position/Title
 
 Are you a member* ?

   Yes   No
 Email
(Registration acknowledgement will be sent here)
 Phone
 Fax

Either:

 

  Registration Fees (PD Event) (include GST)

      ISPI  Member

      PD Event registration                                       

      NON Member

      PD Event registration                                       

 

      OR

 

  Membership 2005 - 2006                                 (Membership Rates)

  Payment details

Amount:  $
 (include cents, eg:  1210.00)

  * Member means a person who is a financial member of ISPI Sydney.

Enquiries
John Loty
Telephone: +61 2 9799 2214
Facsimile: + 61 2 9799 0064
Email: info@ispisydney.org.au

Cancellation
Registration is transferable to a nominated substitute delegate. A full refund is issued to cancellations received one week prior to the Event. Cancellations after this time will be subject to a 75% cancellation fee.

Privacy Statement
The purpose of collecting your personal information is to register you for the PD Event. None of your personal information will be provided to any third party. Your name and organisation will be printed on your Name Tag.