Public Relations Institute of Australiaregistration Form

Public Relations Institute of AustraliaRegistration Form.

NSW: Australian Evaluation Model
Wednesday, 14 August 2013, 9.00am – 1.00pm
A170 / TAX INVOICE
ABN 85 066 451 732
This form becomes a tax invoiceonce payment is made.
Receipt will be provided on request only.

Please complete this form and return to: or F. 02 9279 3888Places can only be reserved after payment has been received. Please read PRIA Refund and Cancellation Policyat before registering.

Title First nameSurname

Position Company

Postal address

Phone Email

Please note: Please note: The following earlybird prices needs to be booked before 17 July 2013bookings after17July 2013will be charged at full rate.(All prices include GST).

PRIA Member earlybird $240.00 / RCG Staff earlybird $352.00 / Non Member earlybird $400.00
PRIA Member full price $300.00 / RCG Staff full price $400.00 / Non Member full price $500.00
Card Type / MasterCard / Visa / Amex / Total Amount to Charge Credit Card: / $
Credit Card Number:
Name of Cardholder: / Expiry Date:
Cardholder Signature: / CVV / Amex Code
Please send me an invoice / Please apply my voucher to this booking – voucher code:

Please list the name, position and email address of attendees below:

NamePositionEmail address

NamePositionEmail address

If you are registering a colleague for this event, please check list theirindividualemail addressfor this registration. If you list your email address, instead of the actual event attendee(s), you will receive a duplication of email updates and the individual will not receive event details or changes to the event.

If the registrations are insufficient PRIA retains the right to cancel a workshop two weeks before the published date and will offer a full return or transfer.

Suite 506, 83York StPlease advise us if you or any members of your group has special dietary requirements:
Sydney NSW 2000

T: 02 9331 3346

F: 02 9331 3559