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 March15, A$500)			$____
Student*			A$250 (after March15, A$300) 			$____
Accompanying†		A$200 (after March15, A$250) 			$____

Biological Structure Workshop (August 13-15)
Full 			A$300 (after March15, A$400)			$____
Student*			A$200 (after March15, A$250) 			$____
Accompanying†		A$150 (after March15, A$200) 			$____

Sagamore Meeting (August 13-18)
Full 			A$500 (after March15, A$650)			$____
Student*			A$300 (after March15, A$400) 			$____
Accompanying†		A$250 (after March15, A$350) 			$____

AsCA’03/Crystal-23 and Biological Structure Workshop (August 10-15)
Full 			A$600 (after March15, A$750)			$____
Student*			A$350 (after March15, A$400) 			$____
Accompanying†		A$300 (after March15, A$350) 			$____

AsCA’03/Crystal-23 and Sagamore Meeting (August 10-18)
Full 			A$800 (after March15, A$900)			$____
Student*			A$450 (after March15, A$500) 			$____
Accompanying†		A$400 (after March15, 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