Registration Form

QCD DOWN UNDER WORKSHOP

10-13 March 2004 in the Barossa Valley

15-19 March 2004 at CSSM, Adelaide

REGISTRATION FORM

PERSONAL INFORMATION :

Title: Prof. Dr Assoc. Prof. Assist. Prof. Mr Ms/Miss/Mrs

Surname:

First Name:

Preferred Name (for name tag) :

Affiliation :

Postal Address:

E-mail Address:

Telephone : + (Country Code)-

Fax : + (Country Code) -

Accademic Position : Faculty Staff PDF Graduate Student Other

If other please specify :

PRESENTATION INFORMATION :

Deadline for abstract submission is 30th January 2004

Do you wish to give a talk at the workshop ? Yes No

If so :

What is the title of your talk ?

Please include your short abstract :

Will you be bringing your own laptop computer? Yes No

REGISTRATION INFORMATION :

Early Bird Registration Fee :	Before 10. December.2003	AUD$ 350.00
Late Registration Fee :	After 10. December.2003	AUD$ 500.00
A cancellation fee of AUD$100.00 will apply to any cancellations made after the 9th of January 2004 and no refunds will be given after the 27th of January 2004.

Please choose one of the following options:

Late registration

Early Bird registration :

I will pay by: Credit Card Cheque

Note: Please visit Registration site for more information about how to pay

TRAVEL INFORMATION :

Arrival/Departure Information :

Arrival date and time at Adelaide :

Departure date and time from Adelaide :

Accompanying Guest Information :

I will NOT have accompanying guests.

I will have accompanying guests.

If so; please provide the names of your guests (for the name tag and hotel booking purposes):

Number of accompanying guest :

ACCOMMODATION INFORMATION :

Please visit Programme and Accommodation sites before answering the following questions :

On Wednesday, the 10th of March 2004 at approximately 2pm there will be a bus leaving University of Adelaide to take participants from Adelaide to the Barossa.

I will take the bus (included in registration fee)

I will arrange my own transportation to the Barossa (at my own expense)

On Sunday the 14th of March 2004 Sunday late afternoon there will be a bus to take participants from the Barossa to Adelaide.

I will take the bus (included in registration fee)

I will arrange my own transportation back to Adelaide (at my own expense)

On Saturday the 13th of March after lunch the workshop will break and reconvene on Monday 15th of March in the CSSM, Adelaide. Most of the local participants will return to Adelaide on Saturday afternoon. However overseas visitors are encouraged to stay in the Barossa until Sunday and enjoy the local wineries.

IN THE BAROSSA :

Novotel Barossa Valley Resort	Prize (per night)	Prize Includes
Studio Suite	AU$191.00 pp-pc*	with king size bed, click here for more details
Studio Suite (twin share)	AU$122.00 pp* where possible, limited number available	with 2 single beds, click here for more details
2 Bedroom Apartments	AU$157.00 pp*	with 1 double and 2 single beds in separate rooms, click here for details

*pp : per person *pc: per couple

Studio Suite (AU$191)

Arriving on Departing on

Studio Suite (AU$122 pp) twin share

Arriving on Departing on

2 Bedroom Apartment (AU$157 pp) for people (twin share)

Arriving on Departing on

I will arrange my own accommodation in the Barossa.

On Monday the 15th of March 2004 the workshop will begin at the CSSM.

IN ADELAIDE :

All Seasons Adelaide Meridien	Prize (per room)	Prize Includes
Standard Suite	AU$95.00 pp-pc	with double size bed, click here for more details
Standard Suite	*AU$95.00 pr or AU$47.50 pp where possible, limited number available**	with 2 single beds, click here for more details
Executive Suite	AUD$123.00	with queen size bed, click here for more details

*pp : per person *pc: per couple *pr: per room

Standard Suite (AU$95.00)

Arriving on Departing on

Standard Suite (AU$47.50 pp) (twin share)

Arriving on Departing on

Executive for (AU$123.00)

Arriving on Departing on

I will arrange my own accommodation in Adelaide.

I have reviewed this form

Page Created: 31 August, 2003

Last Updated: 21 September, 2003

by A. Kizilersu

CSSM, University of Adelaide, Australia 5005 Telephone : +61-8-83033549 Fax: +61-8-83033551

Background image: " Copyright Balarinji", used by permission of www.jumbana.com.au