Where To Next? Registration Form

Where to next? – Issues and Opportunities

Please print out this form and register by 14 February 2004.

Early Bird, 31 January 2004

MAIL: Send your completed registration form to:

Dr Justus H Lewis
Transformasia Pty Ltd
22 Wellington Street
St Kilda Vic 3182

FAX: Fax your completed registration form to:
Dr Justus H Lewis, Transformasia Pty Ltd

03 9537 0167

TELEPHONE: Transformasia

03 9525 3409

First name:

Last name:

Current employment situation/job role:

Employer (if applicable):

Postal address for confirmation of enrolment (Work/Home):

State:

Postcode:

Country:

Email:

Work telephone:

Work Fax:

Home telephone:

Home Fax:

Mobile:

Special dietary or other requirements:

Fees payable (This program is GST free): $350

Students and unemployed $250

Early bird (before 31 January): $300

Two or more from same organization: $300 each

Please debit my Mastercard/VISA

Account no: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Name (as on card):

Expiry date:

Amount:

Signature:

Please invoice my organization (fees must be paid prior to the commencement of the workshop)

Name and address of organization to be invoiced:

I enclose a cheque for:

Please make cheques payable to: Transformasia Pty Ltd

Three issues I would like addressed during the workshop are:

1. ............................................................................................

2. ............................................................................................

3. ............................................................................................

I can’t attend this program but please keep me informed of future events. Yes/No

Delegate Cancellation should be made to justus@transformasia.com.au at least 7 days prior to the program for full refund. There is no refund for cancellations made less than 7 days prior to the program. Delegate substitution is permitted.

TransformAsia Pty Ltd
ACN 097 139 725
Tel: +61 3 9525 3409 (Australia), +65 9069 7189 (Singapore)
E-mail: justus@transformasia.com.au
www.transformasia.com.au