State of the Region

Rebuilding Momentum

Partners & Supporters

Keynote Speakers

Venue

To Register

Please complete this form online or download the pdf and send it to the details below by
26 May 2009

Post it to:
State of the Region Secretariat
Policy Solutions
PO Box 316
Ashgrove Qld 4060

Enquiries

Contact Jenny Prasser at jenny@stateoftheregion.com.au or on 07 33660533

Registration Fees (Inc GST)

Individual (Commercial or Government)

$220.00

Registration Details (* are required)

Person 1
Person 2 (option)

First Name*	A name is required.
Last Name*	A last name is required.
Position*	A position is required.
Organisation*	An organisation is required.
Postal Address*	An address is required.
Town/City*	A suburb is required.
State*	A city/town is required.
Postcode*	A value is required.Invalid format. A postcode number is required.
Telephone*	A value is required.Invalid format. Only numbers, no spaces etc.
Email*	A value is required.Invalid format.
Dietary requirements

First Name
Last Name
Position
Organisation
Street Address
Town/City
State
Postcode	Invalid format. A postcode number is required.
Telephone	Invalid format. Only numbers, no spaces etc.
Email	Invalid format.
Dietary requirements

Additional Registrations

List your group in the ‘Extra Comments’ at the bottom of online registration form or contact the State of the Region Secretariat on the details above

Payment Options

	Cheque - made payable to Policy Solutions
	Please invoice me
	Credit Card* (Tax Invoice Receipt will be issued)

Please make a selection.

*If paying by Credit Card please send the following details:

Name of Registered Attendant/s, Name of Card Holder, Card Type (Visa and MasterCard), Card Number, Expiry Date, and Contact Number.

Send Details to:

Jenny Prasser
Phone: 07 3366 0533
Email: jenny@stateoftheregion.com.au

Extra Comments

Cancellation Policy

Please confirm you agree. I agree with the cancellation policy

Cancellations received by 26 May 2009 will be refunded in full.
Full payment is required for any cancellation received after 26 May 2009, or non-attendance.
Substitutions may be made at any time.
All cancellations or changes must be made in writing by email at info@stateoftheregion.com.au

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