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Please register me for :-

(Day 1 : 10 am - 5 pm )

(Day 2 : 8:30 am – 3 pm)

1 ) CONTACT DETAILS

First Name *

Surname *

-TITLE- Mr Mrs Ms Dr Prof

Company

Email *

Address

Postcode

Locality/Town

--STATE-- NSW QLD VIC ACT SA WA NT TAS

Work Phone

Mobile

Fax

2 ) ATTENDANCE

Full - both days & dinner -->

Day 1 or Day 2 -->

Both days -->

Dinner only -->

* Day registrations also include lunch, tea and coffee

Cost (inc.)

I wish to attend ==>

------ FULL-both days & dinner Day1 Day2 BOTH days Not Attending

""

Dinner (optional) ==>

3 ) EXTRA COPIES OF PROCEEDINGS

I would like to collect ==>

0 1 2 3 4 5 6 7 8 9

?

...extra copies of the proceedings at the conference (@ $40 ea)

POST to me ==>

0 1 2 3 4 5 6 7 8 9

... copies of the proceedings (posted @ $50 ea)

Total- Due ===>

inc. GST

4 ) SUBSCRIBE

Please ..

delete include

..my contact details after the event on ICAN / GRDC’s mailing database of Northern Region Grains Professionals and Growers.

5 ) DIETARY REQUIREMENTS?

*** CANCELLATION / REFUND POLICY ***

To encourage early registration, we will happily refund your registration fee, providing you notify us by Monday 27th February. Cancellations between 27/2/12 and 2/3/2012 will incur a cancellation fee of $30. Refunds will not be provided for cancellations after 2/3/2012.

*** REGISTRATION SUMMARY ***

Name :

Email :

Phone :

Fax:

Event :

I wish to attend :

Dinner :

Proceedings :

Dietary Requests :

""

Total Amount :

Add to Calendar (?)

If details are incorrect please scroll up to amend. Otherwise proceed to secure payment gateway.

Enquiries: ICAN Pty Ltd | Erica McKay | ph (02) 9482 4930

erica@icanrural.com.au

ICAN Website