Registration Form Please complete this form using CAPITAL Letters. All prices are AUD$ and include GST
ATTENDEE INFORMATION (Please print clearly) PROBUS MEMBER Surname: Title: First Name: Preferred name for Name Badge: Probus Club:
YOUR ACCOMPANYING GUEST Surname: Title: First Name: Preferred name for Name Badge: Probus Club:
Postal Address: City: State: Country: Postcode: Tel: Fax: Mobile: Email:
Please advise of any dietry or access requirements:
(A) Registration Fee (Non-Refundable) $100.00 per person x $100 = $
Please indicate in the box the number attending the functions which are included in your Registration. (1 or 2).
Welcome Morning Tea / Lunch & Ceremony
Ecumenical Service
PC-SP Forum & Closing Ceremony
(Hearing Impaired Equipment available on Request)
Farewell Lunch (Hearing Impaired Equipment available on Request)
Please indicate in the box the number attending that require Hearing Impaired Aid for each Ceremony. (1 or 2).
I require Hearing Impaired Aid for Opening Ceremony. I require Hearing Impaired Aid for Closing Ceremony.
(B) Accommodation (first night as a deposit) Check in date: Check out date: Estimated time of arrival:
Check in time is 2.00pm. Departure time is 10.00am at all hotels. Earlier arrival or later departure times may incur an additional nights charge. All costs are on a per room per night basis. All rooms are non-smoking by law.
Please mark 1, and 2 against your hotels of choice. Allocation will be on a first come, first served basis. The Conference Secretariat will do their utmost to meet your requests.
Room type (tick one) Single Twin (two beds) Double
SKYCITY Darwin A1 $260 Holiday Inn Esplanade A2 $250 Crowne Plaza A3 $ 295
Quality Hotel Frontier Darwin A4$172 Vibe Hotel - Waterfront A5$250
Medina Apartment A6 1 Bedroom Apartment $275 A6 Studio $255
Travelodge Mirambenna A7 $260 Palms City Resort A8 $185 Novotel Darwin Atrium A9 $240
Quest Darwin 1 Bed Room Apartment A10 $300 2 Bed Room Apartment A10 $296
Subtotal B; Total Accommodation Cost for choice 1 $ per room x Number of Nights = $ If a credit card number is supplied, it will be passed on to the relevant hotel. The hotel will hold the card details and process the charges once you have arrived. If your booking is cancelled within one month of the event the deposit will be processed and other fees may apply if the room cannot be let by the hotel. Any outstanding charges related to your stay must be settled between yourself and the hotel upon your departure. OR I will arrange my own accommodation at
(C) SOCIAL PROGRAM (DEPOSIT 50%)
(D) FULL DAY TOURS (DEPOSIT 50%)
(E) HALF DAY TOURS (DEPOSIT 50%) CIRCLE MORNING OR AFTERNOON TOUR WHERE APPLICABLE
(G) TRADE TRAVEL EXTENDED TOURING OPTIONS (DEPOSIT IS $200 PER PERSON PER TOUR)
Card Holder Name
Cancellations/Refunds - Terms and Conditions • The registraion fee is non-refundable. • Dinners, tours and other activities, the following will apply: Where notice is given 30 days prior to 1 June 2010 50% of the total cost will be forfeited. Where notice is given 1-29 days prior to 1 June 2010 100% of the total cost will be forfeited. • Pre and Post Tours the following will apply: • The registration fee is non-refundable. • Dinners, tours and other activities, the following will apply: -Where notice is given 30 days prior to 1 June 2010 50% of the total cost will be forfeited. -Where notice is given 1-29 days prior to 1 June 2010 100% of the total cost will be forfeited. • Pre and Post Tours the following will apply: Trade Travel Packages -$200.00 per person non refundable deposit with completed Registration Form. Final Payment due on or before 23 June 2010. -Where notice is given 45 days prior to 1 June 2010 50% of the total cost will be forfeited. Air Adventure Australia Packages - 10% deposit with completed Registration Form - final payment 60 days prior to departure. -Where notice is given 45 days prior to 1 June 2010 50% of the total cost will be forfeited.