Australian Industry Awards 2021

26 OCTOBER 2021, THE STAR, SYDNEY

TABLE AND INDIVIDUAL BOOKINGS Please complete all sections of this form and send to ANZIIF Customer Service at [email protected] Please note that this form will not be processed or table reserved until all sections are complete and payment made. INDIVIDUAL BOOKING TABLE BOOKING

Number of seat(s):______at $375 per seat Number of table(s):______at $3,650 per table of ten Total cost: AU$______Total cost: AU$______Name: ______Company / table name:______Company:______Contact name:______Phone: ______Phone: ______Email: ______Email: ______

TABLE ALLOCATION (Missing attendee names must be provided to customer service by Friday, 8 October)

Guest 1. ______Email ______Phone ______Company______Dietary Requirements

Guest 2. ______Email ______Phone ______Company______Dietary Requirements ______

Guest 3. ______Email ______Phone ______Company______Dietary Requirements ______

Guest 4. ______Email ______Phone ______Company______Dietary Requirements ______

Guest 5. ______Email ______Phone ______Company______Dietary Requirements ______

Guest 6. ______Email ______Phone ______Company______Dietary Requirements ______

Guest 7. ______Email ______Phone ______Company______Dietary Requirements ______

Guest 8. ______Email ______Phone ______Company______Dietary Requirements ______

Guest 9. ______Email ______Phone ______Company______Dietary Requirements ______

Guest 10. ______Email ______Phone ______Company______Dietary Requirements ______PAYMENT DETAILS My registration will be paid by (select one) VISA Master Card Amex Diners Club EFT Account Name Australian and New Zealand Institute of Insurance and Finance Bank National Bank BSB 083 004 Account No 515117195 Branch 330 Collins Street, Account Swift Code NATAAU3303M Email for remittance advice [email protected] To allow us to identify your EFT payment, please enter “AU Awards 2021” and your company name as the statement of reference and email, fax or mail remittance advice. Cardholder’s Name Company Name

Card Number E x p i r y D a t e /

Cardholder’s Signature

EVENT TERMS AND CONDITIONS (Please read carefully) Cancellations made in writing to [email protected] before close of business on Monday, 16 August 2021 will receive a 50% refund. Cancellations made after Monday, 16 August 2021 will receive no refund. ANZIIF collects and stores your personal information for the purposes of providing and promoting continuing programs and membership services. The information you provide will not be released to any other person or organisation without your consent unless required to do so by law. ANZIIF will on occasion be asked to submit delegate names and contact details to event sponsors. To review ANZIIF’s full privacy policy go to anziif.com/about/privacy-statement Please tick if you do NOT wish your name and contact details to be released to the sponsors of this event. Filming for personal and professional purposes is strictly prohibited. If found breaching any of the ANZIIF terms, ANZIIF reserves the right to remove delegates from the event. By attending this event you consent to use of filming and photography at the discretion of ANZIIF. 201PDE_0621