Australian  Society  of  Indonesian  Language  Educators  (ASILE)  Conference  

Canberra,  29  &  30  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  Wednesday  29  September  
 
  I  WILL  NOT  be  attending  the  Conference  dinner  on  Wednesday  29  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)  
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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:  BSU@ADFA.EDU.AU  
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