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Join Us at ASILE 2010

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Australian Society of Indonesian Language Educators (ASILE)

Conference
Canberra, 28 & 29 September 2010

Maju Bersama - Lanjutkan!

Collaboration and Other Learning


Initiatives
Conference Registration
Contact Details
Title (Mr., Dr., etc): ______________________________________________
Last Name: ______________________________________________
First Name: ______________________________________________
Institution: ______________________________________________
Role in institution: ______________________________________________
Address: ______________________________________________
Suburb/City: ______________________________________________
State/Territory: ______________________________________________
Postcode: ______________________________________________
Country: ______________________________________________
Contact number: ______________________________________________
Email : ______________________________________________

Conference Dinner
The Indonesian Embassy will be hosting the conference dinner on Wednesday 29
September at the Embassy, 8 Darwin Avenue, Yarralumla. The evening will
include dinner and entertainment and cost is included in the registration fee. For
catering purposes, please indicate below if you will be attending the dinner.

I WILL be attending the Conference dinner on Tuesday 28 September

I WILL NOT be attending the Conference dinner on Tuesday 28 September

Dietary Requirements
Conference registration INCLUDES lunch and refreshment for the duration of the
conference and the conference dinner. Please indicate below any special dietary
requirements (e.g. vegetarian, soy milk, etc)
___________________________________________________________________________
___________________________________________________________________________
Payments – cheque or credit card

Early Bird conference registration ($200) closes on 15 May 2010.

Normal conference registration ($225) closes Friday 27 August 2010.

A completed registration form together with full payment should be forwarded to:

Business Services Unit, UNSW@ADFA,


Room 101, Building 1
Australian Defence Force Academy,
Canberra, ACT 2600
Email: [email protected]
Fax: 02 6268 8690

Please make cheques payable to the UNSW@ADFA.


Alternatively you may pay using a credit card. Mastercard, Visa and Bankcard are
accepted. Please indicate your method of payment and complete the details
below.

Cheque (please attach to form)

Credit Card

Please use the details below to debit my credit card


Name on credit card: ______________________________________________
Credit card Type: ______________________________________________
Credit card number: ______________________________________________
Credit card Expiry Date: ______________________________________________
Amount: ______________________________________________
Signature: ______________________________________________

This form becomes a Tax Invoice on payment. Fees include GST.


ABN 57 195 873 179

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