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WATER INDUSTRY OPERATORS ASSOCIATION OF AUSTRALIA ABN 83 123 468 422

72nd Victorian Water Industry Engineers & Operators Conference

TAX INVOICE / REGISTRATION FORM

This form becomes a TAX INVOICE on receipt of payment. Please retain a copy for your records.

Employer: Employer ABN: Address:

Phone: (Work) Email:(for confirmation)

Delegates Attending:

(Note: Details collected will be used on a Delegates list.) WIOA Indiv. Member

1. Name: Position / Title:

Yes No

Contact Telephone No.: Email:

2. Name: Position / Title:

Yes

No

Contact Telephone No.: Email:

3. Name: Position / Title: Contact Telephone No.:

Yes

No

Email: REGISTRATION

Full Conference Single Day (Tick Day)

Qty: WIOA Ind Member @ $440 Inc GST pp

@ $308 Inc GST pp

Wed Thurs

Qty: Non-Member

@ $495 Inc GST pp $

@ $352 Inc GST pp $

$ TOTAL AMOUNT PAYABLE

REGISTRATIONS CLOSE 27 August 2009 PAYMENT MUST ACCOMPANY THE REGISTRATION FORM.

2% Administration Fee on all credit card payments

VISA MASTERC

ARD

CHEQUE

EFT

Cardholder’s Name Number Cardholder’s Signature

Expiry Date

/

Cheques Made payable to: WIOA Mail to: WIOA Ltd PO Box 6012, Shepparton, VIC, 3632

EFT details: Westpac Bank BSB: 033 254 Ac No.: 32 7012 Fax Remittance notice to: 03 5821 6033

WIOA Contact Details Ph: 03 5821 6744, Fax: 03 5821 6033, Email: info@wioa.org.au

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