ABN 25 000 715 453

Event Registration Form(State)

Please note: If you would prefer an instant, printable confirmation of registration & receipt of payment, please register online.

Event
Name: / Event
Date: / State:
Attendee Full Name / Email address / Fee*(incl. GST)
$ .00
$ .00
$ .00
$ .00
*Please see the Concrete Institute of Australia website for Event Fee
Registration fees must be paid prior to the event. Numbers may be limited, please register and pay no later than 3 working days prior to the event to avoid disappointment.
Please Note:
No refunds will be made for registrant cancellations however an alternate registrant may attend the event. / Total
$ .00
Company name
Postal address
City: State: P/code:
Phone
Fax

I/we wish to pay by: (please tick)Cheque (made payable to theConcrete Institute of Australia)

Credit Card:VisaMaster CardAmex

Card number: Expiry date: /

Cardholders Name: …………………………………………….… Cardholders Signature: ………………………………..……..

Do you wish to receive an Invoice for this payment?(please tick) No Yes

If Yes, how would you like this to be sent to you? by Email  by Fax  by Mail

Please return your registration and payment to the Concrete Institute of Australia at the appropriate State Branch Office:

NSW Branch
PO Box 3157
RHODES
NSW 2138
Ph: 61 2 9736 2955
Fax: 61 2 9736 2639
Email: / QLD Branch
Suite 2, Level 2
485 Ipswich Rd
ANNERLEY
QLD 4103
Ph: 61 7 3892 6668
Fax: 61 7 3892 5655
Email:
/ VIC Branch
Level 2, 1 Hobson St
SOUTH YARRA
VIC3141
Ph: 61 3 9804 7834
Fax: 61 3 9827 6346
Email:
/ SA Branch
PO Box 559
MARDEN
SA 5070
Ph: 61 8 8362 1922
Fax: 61 8 8362 1822
Email:
/ WA Branch
45 Ventnor Ave
WEST PERTH
WA 6005
Ph: 61 8 9389 4447
Fax: 61 8 9389 4451
Email:
/ TAS Branch
2 Davey Street
HOBART
TAS 7000
Ph: 61 3 6225 2932
Fax: 61 3 6225 3939
Email: