Conference Registration

Please complete the Conference Online Registration Form or alternatively, download, complete and fax this form to (02) 6882 0504. Please contact us with any queries.

* Required

Personal Information - Please complete a registration form for each attending delegate
Registrant Type * Delegate Exhibitor
Title DR MISS MR MRS MS	First Name *	Last Name *
Organisation (If Applicable)		ABN
Student Training Facility (If Applicable)		Student No
Address *
City *	State *	Postcode *
Country * -- Select Country -- AFGHANISTAN ALAND ISLANDS ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CâTE D'IVOIRE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HEARD ISLAND AND MCDONALD ISLANDS HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PALESTINIAN TERRITORY, OCCUPIED PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA AND MONTENEGRO SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES UNITED STATES MINOR OUTLYING ISLANDS URUGUAY UZBEKISTAN VANUATU VENEZUELA VIETNAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE
Phone Number	Mobile Number	Email Address *

Date	Event	Number	Cost	Total
Mon 22nd Oct 2012	Carbon Farming 101 - learning the basics  Half day workshop		$110 per person
Mon 22nd Oct 2012	Welcome Event		$45 per person
Tues 23rd Oct 2012	Carbon Cocky Awards Gala Dinner		$95 per person
Tues & Wed 23rd & 24th Oct 2012	2 day Carbon Farming Conference & Expo		$295 per person
Tues & Wed 23rd & 24th Oct 2012	Discounted Rate for Farmer Delegates to 2 day Carbon Farming Conference & Expo		$250 per person
Thurs 25th October 2012	Advanced Carbon Farming – on farm project Implementation ½ day Workshop		$110 per person
Tues 23rd Sept 2012	1 day Exhibitor (Festival of Fertiliser Expo) (with Workshop Opportunities) (Name Tag Required)		Included
Wed, Thurs 24th & 25th Sept 2012	2 day Exhibitor (Carbon Farming Expo) (Name Tag Required)		$225 per person
Tues, Wed, Thur 23th 24th 25th Sept 2011	3 day Exhibitor (2 day Carbon Farming Expo + 1 day Festival of Fertiliser Expo) (Name Tag Required)		$225 per person
			SUB TOTAL
			Less 50% (Student Discount if Applicable)
			TOTAL

Name Tags (Separate multiple names with commas)
Carbon Farming 101 Seminar Name Tags *
Welcome Event Name Tags *
Carbon Cocky Awards Dinner - Name Tags *
Carbon Farming Conference Name Tags *
Advanced Carbon Farming – on farm project Implementation ½ day Workshop - Name Tags *
1 day Exhibitor - Delegate Pass - Name Tags *
2 day Exhibitor - Delegate Pass - Name Tags *
3 day Exhibitor - Delegate Pass - Name Tags *

Payment Information
Payment Method * Credit Card  Direct Deposit  Cheque
Name on Card *
Card Type * Visa Master Card	Card Number *
Card Expiry * 01 02 03 04 05 06 07 08 09 10 11 12 2012 2013 2014 2015 2016 2017 2018 2019 2020	CCV Number *
Direct Deposit Details BSB: 633 111 Account No: 3018 26277
Cheque/Money Order Details Carbon Farmers of Australia. PO Box 640, Dubbo, NSW, 2830
Amount *