Registration form - ATNF Synthesis Imaging Workshop. 14-18 September 1998
-------------------------------------------------------------------------
Name:

Gender (F/M):

Affiliation:

Address:

FAX:

Telephone:

E-Mail:

Professional status: 
(undergraduate, postgraduate, post-doc, staff)

Registration fee.         Cost $60 (Y/N):
Late fee (after 24/8/98). Cost $10 (Y/N):

Accommodation:
--------------
Cabin share (up to 5 people): (Y/N)

Motel room share (2-3 people): Y/N

Sharing with:
or leave blank if you don't mind with whom.

Individual room (single/double): 

Travel
------
Transport: Car, Train, Aeroplane, Coach? 

Estimated arrival/departure dates & times:  
     Arrival:                   Departure:

Accompanied by:

Would you be using the CSIRO bus from and to Sydney? (Y/N)
Bus fare $50 (Y/N):

Assistance
----------
Do you require student travel assistance (Y/N):
If Yes please specify (e.g. CSIRO bus to Narrabri):

Do you require student accommodation assistance (Y/N):
If Yes please specify (e.g. 5 nights, Mon-Fri):

Could you please attach a few lines to justify the assistance:


If Yes are you receiving any other assistance: 

Students requesting assistance will be advised of the amount granted
before the Workshop.

PAYMENTS
--------
Payment of Registration can be by credit card or cheque

If paying by Credit Card fill in the Following:

Please charge my (Visa,Mastercard,Bankcard) the sum of $_ _ _ _

Credit Card Number_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Expiry Date _ _ _ _ _ _ _    Name on Card:

Signature (if posting or faxing): 


If paying by cheque make payment to "Astronomical Synthesis Imaging Workshop"
and mail to:  Joanne Houldsworth
Locked Bag 194, Narrabri, NSW 2390, AUSTRALIA 
Credit card payments may be faxed on (02) 6790 4090
Email to "synthesis@atnf.csiro.au"

REGISTRATION DEADLINE AUGUST 24 OR LATE FEE OF $10 TO APPLY