Registration Form
ATNF Synthesis Imaging Workshop
14-18 September 1998
REGISTRATION DEADLINE AUGUST 24 OR LATE FEE OF $10 TO APPLY
Personal Information
Name:
Gender:
Male
Female
Affiliation:
Address:
FAX:
Telephone:
E-Mail:
Professional status:
undergraduate
postgraduate
post-doc
staff
Registration fee
Cost $60:
Yes
No
Late fee (after 24/8/98).
Cost $10:
Yes
No
Accommodation
Cabin share
(up to 5 people):
Yes
No
Motel room share
(2-3 people):
Yes
No
Sharing with:
or leave blank if you don't mind with whom.
Individual room
single
Yes
No
or double
Yes
No
Travel
Transport:
Car
Train
Aeroplane
Coach
Estimated dates & times:
Arrival
AM
PM
Departure
AM
PM
Accompanied by:
Would you be using the CSIRO bus from and to Sydney?
Yes
No
From Sydney only
To Sydney only
Bus fare $50:
Yes
No
Half fare
Assistance
Do you require student travel assistance:
Yes
No
If Yes then specify
e.g. CSIRO bus to Narrabri
Do you require student accommodation assistance:
Yes
No
If Yes then specify
e.g. 5 nights, Mon-Fri
Could you please write a few lines to justify the assistance?
Are you receiving any other assistance:
Students requesting assistance will be advised of the amount granted before the Workshop.
Payment
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