Registration Form

Broome 2003 Crystallography Meetings

Surname: |_______________________________|

First Name: |_______________________________|

Title: |___________|

Accompanying Person Names: |_____________________________________|

Affiliation Institute: |____________________________________________|

Postal Address: |____________________________________________|

Street |____________________________________________|

City & Code |____________________________________________|

Country |____________________________________________|

E-mail Address: |_______________________|

Phone Number: |_______________| Fax Number: |_______________|

Registration Fees

AsCA’03/Crystal-23 (August 10-13)

Full A$400 (after April 15, A$500) $____

Student* A$250 (after April 15, A$300) $____

Accompanying† A$200 (after April 15, A$250) $____

Biological Structure Workshop (August 13-15)

Full A$300 (after April 15, A$400) $____

Student* A$200 (after April 15, A$250) $____

Accompanying† A$150 (after April 15, A$200) $____

Sagamore Meeting (August 13-18)

Full A$500 (after April 15, A$650) $____

Student* A$300 (after April 15, A$400) $____

Accompanying† A$250 (after April 15, A$350) $____

AsCA’03/Crystal-23 and Biological Structure Workshop (August 10-15)

Full A$600 (after April 15, A$750) $____

Student* A$350 (after April 15, A$400) $____

Accompanying† A$300 (after April 15, A$350) $____

AsCA’03/Crystal-23 and Sagamore Meeting (August 10-18)

Full A$800 (after April 15, A$900) $____

Student* A$450 (after April 15, A$500) $____

Accompanying† A$400 (after April 15, A$450) $____

* Student registrations accepted following an e-mail (org@broome2003.uwa.edu.au) from supervisor.

† Persons over 12years (fee covers cost of evening events).

• Fax or Post or Email this form to: +61 8 93801066 or “Broome Conference Registration”, Extension Services, University of WA, Nedlands 6009, Australia or janwood@cyllene.uwa.edu.au.

• Payment to be made by telegraphic transfer (TT) or bank cheque to:

University of Western Australia General Account (000086), Westpac Banking Corporation, 109 St George's Tce, Perth WA 6000; BSB Number: 036-054.

Email confirmation of the TT to: janwood@cyllene.uwa.edu.au