<p> CleanUp 2015 Group Registration Form </p><p>Organisation Name of person co-ordinating registrations Position Held</p><p>Postal Address</p><p>City State Postcode</p><p>Telephone Email (for tax invoice and receipts)</p><p>REGISTRATION </p><p>Registration Fees: Group registration fees only apply when 5 or more delegates employed by the same organisation are registered at the same time.</p><p>Category Earlybird Standard Late Registration Group full registration $1345 $1445 $1545 Pre-conference Workshops and Post-conference Site Visit Full Day $650 $650 $650 Half Day $350 $350 $350 Site Visit $80 $80 $80</p><p>Earlybird registration close: 31 July 2015; Standard registration close: 31 August 2015; Late registration open: 1 September 2015</p><p>PAYMENT ABN: 60 383 512 852 All fees are in Australian Dollars and include GST</p><p>Registration fee: $ x ______delegates = $</p><p>Workshop fee:</p><p>Full day workshop: $ 650.00 x ______delegates = $ Total Fee Payable Half day workshop: $ 350.00 x ______delegates = $</p><p>Site visit fee: $ 80.00 x ______delegates = $ </p><p>Conference dinner $ 160.00 x ______delegates = $ </p><p>TOTAL PAYABLE: $______</p><p> Credit card payment Card Type (Visa, MasterCard or American Express) Card number</p><p>Expiry date</p><p>Cardholder name</p><p>Cardholder signature or  Please send me an invoice or  EFT: Bank of South Australia BSB: 105-146 Account #: 026 265 440 Account Name: Cleanup Conference (Please include organisation name on transfer) DELEGATE DETAILS Please complete details for each person attending and indicate which Workshop or Site Visit each person is attending</p><p>Conference Workshop(s) Dinner Site Visit First Name Last Name State Email (you must complete this field) Special Requirements (dietary, etc) Indicate (Indicate # Indicate site name workshop # of tickets)</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>Please email completed form (2 pages) to [email protected] or</p><p>Fax completed form (2 pages) to +61 (0) 8 8379 8177</p><p>Conference Secretariat: Plevin and Associates Pty Ltd PO Box 54 Burnside South Australia 5066 Tel: +61 8 8379 8222 Fax: +61 8 8379 8177 Email: [email protected]</p>