regform

STAR 2002

Please complete the following sections before remitting:

Family Name: ______________________________________________

    Given Name:   _____________________________________________
    Title: Ms, Mr, Mrs, Dr, Prof, Other (please specify) ________________
    Affiliation: _________________________________________________
    Mailing address: ___________________________________________
    _________________________________________________________
    email: ____________________________________________________
    Telephone (including country & area codes) ______________________
    Fax (Including country & area codes) ___________________________

Your Registration Fee includes:
All Sessions and Keynote Addresses, Morning and Afternoon Teas, Luncheon, Cocktail Party and Taxes
Please insert and add fees in the Total Column

	Before April 30th 2002 AUD $	After May 1st 2002 AUD $	TOTAL AUD $
STAR MEMBERS - General	290	370
STAR MEMBERS from Eastern Europe & developing countries & all Student Members	190	230
NON MEMBERS - General	360	440
NON MEMBER Full-time Students and Colleagues from developing and eastern european countries	230	290
CONFERENCE DINNER	80	80
Extra Dinner Reservation (each)	80	80
COCKTAIL PARTY	N/C	N/C	Attending/Not Attending
Extra Cocktail Party Tickets (each)	30	30
		TOTAL AMOUNT DUE	AUD $

For a currency converter go to http://www.oanda.com/index.htm
NOTE: 75% refund if requested before May 15th, 2002. No refund after this date

Methods of Payment
(Please circle method of payment - 1, 2, 3)

1. I enclose a cheque payable to Deakin University
(with no costs to the beneficiary)
or
2. I authorise you to charge my Visa Card
or
3. I authorise you to charge my Mastercard

Card Number ___________________________________________________
    Expiry Date      __________________________________________________
    Name of Cardholder      __________________________________________
    Address of Cardholder ___________________________________________
    ________________________________________________________________
    Amount to Charge: AUD $ ________________________________________
    Signature of Cardholder      _______________________________________
Remit to:
    STAR2002                                or         For credit card payments only you may
    School of Psychology
    Deakin University                                Fax to   + 61 3 9244 6858
    221 Burwood Hwy
    Burwood 3125 Australia

NOTE: Deakin University ABN 56 721 584 203
Upon payment, this form becomes your tax invoice
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