AA

CM

AC

SYD

NEY

201

8 A

ustr

alas

ian

Acu

punc

ture

& C

hine

se M

edic

ine

Ann

ual C

onfe

renc

e 18

– 2

0 M

ay 2

018

Hol

me

Bui

ldin

g, S

cien

ce R

oad,

Cam

perd

own

Cam

pus,

U

nive

rsity

of S

ydne

y N

SW

200

6 A

ustra

lia

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ISTR

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ON

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ATE

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AIL

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r M

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Y

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OS

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DE

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TRY

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re y

ou a

lso

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ittin

g an

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tract

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ral o

r pos

ter p

rese

ntat

ion?

Yes

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TE R

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Y T

ICK

ET

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AY

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Y

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CK

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RTY

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AY

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E C

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ION

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e fo

r pric

e)

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ION

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KE

TS O

NLY

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E N

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AY

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ATE

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KE

TS O

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Spec

ial R

equi

rem

ents

V

eget

aria

n

Veg

an

Coe

liac

O

ther

(Ple

ase

prov

ide

deta

ils)

PAYM

ENT

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AIL

S –

SEE

LAST

PA

GE

FOR

DEL

EGA

TE R

ATE

S PA

YMEN

T:

The

dele

gate

fee

mus

t be

paid

in fu

ll be

fore

con

fere

nce

regi

stra

tion

will

be

conf

irmed

. P

aym

ent m

ust b

e m

ade

in A

ustra

lian

dolla

rs (A

UD

).

Che

ques

/ban

k dr

afts

/mon

ey o

rder

s to

be

mad

e ou

t to

AA

CM

A. A

dditi

onal

cha

rges

will

app

ly if

pay

men

t is

mad

e in

oth

er c

urre

ncie

s.

C

AN

CE

LLA

TIO

N F

EE

S: P

leas

e se

e pa

ge o

ver f

or th

e ca

ncel

latio

n po

licy.

I enc

lose

$

b

eing

pay

men

t via

C

hequ

e/M

oney

Ord

er

OR

Cre

dit C

ard

V

isa/

Mas

terC

ard

A

ME

X

Din

ers

(5%

sur

char

ge fo

r Din

ers

Clu

b)

I aut

horis

e th

e w

ithdr

awal

of

$

fro

m th

e fo

llow

ing

card

:

Car

dhol

der’s

Nam

e

C

ard

Num

ber

E

xpiry

Dat

e M

M/Y

Y

/

S

igna

ture

In a

ccor

danc

e w

ith th

e A

ustra

lian

Priv

acy

Act

198

8, a

ll pe

rson

al in

form

atio

n pr

ovid

ed w

ill b

e tre

ated

as

conf

iden

tial a

nd u

sed

by th

e co

nfer

ence

org

anis

er

to re

gist

er y

ou fo

r con

fere

nce

func

tions

and

to k

eep

you

info

rmed

of c

onfe

renc

e in

form

atio

n. A

ll de

lega

tes

will

be

supp

lied

with

a p

erso

nalis

ed la

nyar

d (id

entif

icat

ion

tag)

dis

play

ing

nam

e an

d S

tate

/Cou

ntry

. Thi

s m

ust b

e w

orn

at a

ll tim

es d

urin

g th

e co

nfer

ence

and

the

orga

nise

r res

erve

s th

e rig

ht to

refu

se

entry

to a

ny p

erso

n w

ho fa

ils to

wea

r or d

ispl

ay th

eir p

erso

nalis

ed la

nyar

d. A

list

of d

eleg

ates

with

sta

te/c

ount

ry w

ill b

e in

clud

ed in

the

conf

eren

ce p

ack.

It

is a

con

ditio

n of

regi

stra

tion

and

entry

to th

e co

nfer

ence

that

you

agr

ee to

the

abov

e te

rms

and

cond

ition

s fo

r the

use

of y

our p

erso

nal i

nfor

mat

ion.

Nam

e

S

igne

d

D

ate

DD

/MM

/YY

/

/

Plea

se fo

rwar

d co

mpl

eted

form

with

pay

men

t to

AA

CM

AC

Syd

ney

2018

: PO

Box

163

5, C

OO

RPA

RO

O D

C Q

LD 4

151

AU

STR

ALI

A

FAX

+61

7 33

94 2

399

or e

mai

l aac

ma@

acup

unct

ure.

org.

au

AA

CM

AC

SYD

NEY

201

8 A

ustr

alas

ian

Acu

punc

ture

& C

hine

se M

edic

ine

Ann

ual C

onfe

renc

e 18

– 2

0 M

ay 2

018

Hol

me

Bui

ldin

g, S

cien

ce R

oad,

Cam

perd

own

Cam

pus,

U

nive

rsity

of S

ydne

y N

SW

200

6 A

ustra

lia

REG

ISTR

ATI

ON

FO

RM

– D

ELEG

ATE

S

PER

SON

AL

DET

AIL

S

TITL

E

Pro

f D

r M

r M

s

Mrs

M

iss

FA

MIL

Y N

AM

E

G

IVE

N N

AM

ES

A

AC

MA

ME

MB

ER

NO

PH

ON

E

FA

X

E

MA

IL

AD

DR

ES

S

SU

BU

RB

/TO

WN

/CIT

Y

S

TATE

P

OS

TCO

DE

/ZIP

CO

UN

TRY

A

re y

ou a

lso

subm

ittin

g an

abs

tract

for o

ral o

r pos

ter p

rese

ntat

ion?

Yes

DEL

EGA

TE R

EGIS

TRA

TIO

N

3

DA

Y T

ICK

ET

F

RID

AY

18

MA

Y

SA

TUR

DA

Y 1

9 M

AY

S

UN

DA

Y 2

0 M

AY

$

2

DA

Y T

ICK

ET

(TIC

K T

WO

BO

XE

S)

FR

IDA

Y 1

8 M

AY

S

ATU

RD

AY

19

MA

Y

SU

ND

AY

20

MA

Y

$

1

DA

Y T

ICK

ET

(TIC

K O

NE

BO

X)

FR

IDA

Y 1

8 M

AY

S

ATU

RD

AY

19

MA

Y

SU

ND

AY

20

MA

Y

$

CO

CK

TAIL

PA

RTY

– F

RID

AY

18 M

AY

C

ON

FER

EN

CE

DE

LEG

ATE

I

WIL

L A

TTE

ND

TH

E C

OC

KTA

IL P

AR

TY

NO

CH

AR

GE

A

DD

ITIO

NA

L TI

CK

ET(

S)

NU

MB

ER

OF

AD

DIT

ION

AL

TIC

KE

TS:

(see

last

pag

e fo

r pric

e)

$

NA

ME

(S) F

OR

AD

DIT

ION

AL

TIC

KE

TS O

NLY

BA

RB

ECU

E N

IGH

T –

SATU

RD

AY

19 M

AY

C

ON

FER

EN

CE

DE

LEG

ATE

I WIL

L A

TTE

ND

TH

E B

AR

BE

CU

E N

IGH

T $

A

DD

ITIO

NA

L TI

CK

ET(

S)

N

UM

BE

R O

F A

DD

ITIO

NA

L TI

CK

ETS

:

(see

last

pag

e fo

r pric

e)

$

NA

ME

(S) F

OR

AD

DIT

ION

AL

TIC

KE

TS O

NLY

TOTA

L PA

YAB

LE

$

Spec

ial R

equi

rem

ents

V

eget

aria

n

Veg

an

Coe

liac

O

ther

(Ple

ase

prov

ide

deta

ils)

PAYM

ENT

DET

AIL

S –

SEE

LAST

PA

GE

FOR

DEL

EGA

TE R

ATE

S PA

YMEN

T:

The

dele

gate

fee

mus

t be

paid

in fu

ll be

fore

con

fere

nce

regi

stra

tion

will

be

conf

irmed

. P

aym

ent m

ust b

e m

ade

in A

ustra

lian

dolla

rs (A

UD

).

Che

ques

/ban

k dr

afts

/mon

ey o

rder

s to

be

mad

e ou

t to

AA

CM

A. A

dditi

onal

cha

rges

will

app

ly if

pay

men

t is

mad

e in

oth

er c

urre

ncie

s.

C

AN

CE

LLA

TIO

N F

EE

S: P

leas

e se

e pa

ge o

ver f

or th

e ca

ncel

latio

n po

licy.

I enc

lose

$

b

eing

pay

men

t via

C

hequ

e/M

oney

Ord

er

OR

Cre

dit C

ard

V

isa/

Mas

terC

ard

A

ME

X

Din

ers

(5%

sur

char

ge fo

r Din

ers

Clu

b)

I aut

horis

e th

e w

ithdr

awal

of

$

fro

m th

e fo

llow

ing

card

:

Car

dhol

der’s

Nam

e

C

ard

Num

ber

E

xpiry

Dat

e M

M/Y

Y

/

S

igna

ture

In a

ccor

danc

e w

ith th

e A

ustra

lian

Priv

acy

Act

198

8, a

ll pe

rson

al in

form

atio

n pr

ovid

ed w

ill b

e tre

ated

as

conf

iden

tial a

nd u

sed

by th

e co

nfer

ence

org

anis

er

to re

gist

er y

ou fo

r con

fere

nce

func

tions

and

to k

eep

you

info

rmed

of c

onfe

renc

e in

form

atio

n. A

ll de

lega

tes

will

be

supp

lied

with

a p

erso

nalis

ed la

nyar

d (id

entif

icat

ion

tag)

dis

play

ing

nam

e an

d S

tate

/Cou

ntry

. Thi

s m

ust b

e w

orn

at a

ll tim

es d

urin

g th

e co

nfer

ence

and

the

orga

nise

r res

erve

s th

e rig

ht to

refu

se

entry

to a

ny p

erso

n w

ho fa

ils to

wea

r or d

ispl

ay th

eir p

erso

nalis

ed la

nyar

d. A

list

of d

eleg

ates

with

sta

te/c

ount

ry w

ill b

e in

clud

ed in

the

conf

eren

ce p

ack.

It

is a

con

ditio

n of

regi

stra

tion

and

entry

to th

e co

nfer

ence

that

you

agr

ee to

the

abov

e te

rms

and

cond

ition

s fo

r the

use

of y

our p

erso

nal i

nfor

mat

ion.

Nam

e

S

igne

d

D

ate

DD

/MM

/YY

/

/

Plea

se fo

rwar

d co

mpl

eted

form

with

pay

men

t to

AA

CM

AC

Syd

ney

2018

: PO

Box

163

5, C

OO

RPA

RO

O D

C Q

LD 4

151

AU

STR

ALI

A

FAX

+61

7 33

94 2

399

or e

mai

l aac

ma@

acup

unct

ure.

org.

au