To Make Your Booking for the Young Retailer of the Year

REGISTRATION FORM & TAX INVOICE

To make your booking for the Young Retailer of the Year Future of Retail Forum and/or Awards Dinner, return this form by: Fax: (07) 3240 0152 | Email: [email protected] | Mail: PO Box 1544 Coorparoo DC Qld 4151

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Please insert the number of each type of ticket you wish to purchase next to the options below. All prices are shown inclusive of GST. Early bird tickets can be purchased up until Friday, 29 August. FUTURE OF RETAIL FORUM GALA DINNER & AWARDS CEREMONY Date & Time: Friday, 26 September: 9.00am – 3.30pm Date: Friday, 26 September: 6.00pm – 11.00pm Venue: Brisbane Room, Sofitel Sydney Wentworth Venue: Wentworth Ballroom, Sofitel Sydney Wentworth Includes: Refreshments on arrival, morning tea & lunch Includes: Three course sit down dinner & drinks x Complimentary Forum Ticket (Young Retailer Entrant) x Complimentary Ticket (Young Retailer Finalist) x Early Bird Member Forum Ticket ($385) x Entrant Dinner Ticket ($154) x Early Bird Non-Member Forum Ticket ($495) x Early Bird Member Dinner Ticket ($165) x Member Forum Ticket ($495) x Early Bird Non-Member Dinner Ticket ($176) x Non-Member Forum Ticket ($605) x Member Dinner Ticket ($220) x Non-Member Dinner Ticket ($242)

* Tables for the Gala Dinner will seat 8 to 10 comfortably. All names and dietaries are to be provided by Monday, 22 September. Dietary Attending Attending Name Title Requirements Forum? Dinner? 1. Y | N Y | N 2. Y | N Y | N 3. Y | N Y | N 4. Y | N Y | N 5. Y | N Y | N 6. Y | N Y | N 7. Y | N Y | N 8. Y | N Y | N 9. Y | N Y | N 10. Y | N Y | N 11. Y | N Y | N 12. Y | N Y | N

PAYMENT DETAILS / PURCHASE SUMMARY Total Number of Forum tickets: Total Number of Dinner Tickets: Are you a member? Yes No Member ID Total amount: $ Card Type: Visa MasterCard Amex (NB: will incur a 1% surcharge) Credit Card Number: Expiry Date: Name on Card: Authorised Signature:

You may pay via EFT to: National Retail Association Ltd You may pay by cheque to: National Retail Association Ltd BSB: 124 001 Account: 1057 4478

Payment Policy: Payment is due in full at the Cancellation Policy: If you are unable to DISCLAIMER: The personal Program Changes: NRA reserves the right to time of registration. Payment for the Forum attend, a substitute delegate is welcome at no information you provide as part of this modify or alter the event program including the includes refreshments, morning tea and lunch. extra charge. No refunds will be provided for registration will be treated in advertised speakers without notice. Please note that Payment for the Gala Dinner includes a three cancellations within 7 days of the event or for accordance with the NRA’s privacy the speakers and topics were confirmed at the time course dinner and five hour drinks package. delegates who do not attend. Cancellations policy and you may receive future of publication, however, circumstance beyond the Registrations will be confirmed by email upon received more than 21 days prior to the event marketing material from NRA or its control of NRA may necessitate substitutions, receipt of payment. will receive a refund. partners. alterations or cancellations of individual speakers and topics. Please tick if you do not wish to receive further contact from the NRA or its partners