BOOKING FORM 2017 BGANZ Congress | 22-25 October 2017 | Adelaide Name: _____________________________________________________________________________________________________ Position: ___________________________________________________________________________________________________ Organisation: _______________________________________________________________________________________________ Postal Address: ______________________________________________________________________________________________ State: _______________ Postcode: _____________________
Phone: __________________________________________
Email: _____________________________________________
Mobile: __________________________________________
My organisation would like to place a booking request for the following sponsorship package/s:
❏ Congress Dinner (Wednesday 25 October 2017) ❏ Welcome Reception (Sunday 22 October 2017) ❏ Congress Lunch (Monday 23 October 2017) ❏ Congress Lunch (Wednesday 25 October 2017) ❏ Travel Assistance Grants (5 attendees) ❏ Advertisement in Programme Handbook
……………………………………………. $5,500 ……………………………………………. $4,000 ……………………………………………. $2,500 ……………………………………………. $2,500 ……………………………………………. $2,500 ……………………………………………. $800
Payment details
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I will pay by EFT, and note that the banking details will be on the invoice
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I will pay by credit card, and authorise the amount of $ ____________ plus card fees to be charged as follows:
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Visa (+2%)
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Mastercard (+2%)
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AMEX (+3%)
Card number: ____________________________________________ Expiry date: ________________________________________ Card holder name: ________________________________________ Signature:
________________________________________
Please note that debits to your credit card will appear as “Kaigi Conferencing and Events” on your credit card statement
Please send the completed booking form to the Conference Secretariat: Kaigi Conferencing and Events | Level 1, The Realm, 18 National Circuit, Barton ACT 2600 | Email: bganz@kaigi.com.au | Fax: 02 6198 3232