Asia Pacific Conference on Reproductive Health (APCRH)

Law and Culture: Compatibility or conflict No Refund for cancellations received after August 30 2013 9 – 11 September 2013 USP Emalus Campus, Port Vila D. TOTAL COST R E G I S T R A T I O N F O R M No. of persons Cost Please delete payment options that do not apply: A. DELEGATE  Early registration full delegate: 18,000 (Mark with X) Prof. Dr. Mr. Ms. Miss vatu Mrs  Registration full delegate: 23,000 vatu Last Name:  Registration full time student: 12, 000 First Name: : M Middle Initial : vatu  Single day registration: 8,000 vatu per Institution: day Position :  Attendee: 0 vatu Extra opening function ticket: 5,000 vatu Address: Total

Tel. No.: Fax: E-mail: If registering for one day please specify day of attendance: ______Dietary Restrictions, if any : ______E. METHODS OF PAYMENT B. REGISTRATION FEE

Note: The registration fee for full delegates and full time students includes Option A. I have remitted ______vatu through morning tea, afternoon tea and lunch for each day of the conference, dinner at to: the welcome function on 9 September and a conference pack. Single day registration includes a conference pack, morning tea, afternoon tea and lunch. (Name of your Bank/Transfer Service) Bank: Westpac Banking Corporation Attendees are welcome to attend all sessions, but are not provided with meals, Account Name: USP Emalus Campus a conference pack or a ticket to the welcome function. You will be added to the Account Number: 20-002798-73 email list for updates on conference information. Unregistered people are also BSB Number: 039-033 welcome to attend all sessions. When making your transfer please use Law and culture as the reference for the transfer. Please also scan and email a copy of your telegraphic transfer Before 31 July After 1 August form to [email protected] Full Delegate 18,000 vatu 23,000 vatu

Full time 12,000 vatu 12,000 vatu Option B. Please charge ______vatu to my VISA. student Single day 6,000 vatu 6,000 vatu Card Number ______Expiration Date ______Printed Name ______Extra opening 5,000 vatu 5,000 vatu function ticket Signature (when by Mail or Fax)______Attendee 0 vatu 0 vatu By providing and sending the details of my account, I hereby authorize USP to charge my total registration fees to my credit card.

C. CANCELLATION / REFUND POLICY ______Date Signature (when by Mail or Fax) All cancellations must be made in writing and sent to [email protected] Please send a copy of the front and back of your credit card with this form. 80% Refund for cancellations received on/before August 30 2013 Option C. I will pay on arrival. (You cannot use this option for early registrations.)

Please Mail, Fax or Send this Form as an E-mail Attachment to: Law and Culture Conference, USP Emalus Campus; PMB 9072; Port Vila; Vanuatu Fax: (678) 27785 E-mail: [email protected]