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CSIRO Astronomy and Space Science

Radio Astronomy School 2012
24 ­ 28 September Participant Payment Form
Registration is only complete on receipt of full payment.
School Registration Fees: First name Institution Contact phone Email address Postal address Fax $175 Last name

Payment details
Credit Card Type Card Number Name on card Signature Visa MasterCard Diners Expiry Date

FAX or email completed form to:

Office Use Only Cost code: Date received: Registration no:

Amanda Gray CSIRO Astronomy and Space Science PO Box 76, Epping NSW 1710
Amanda.Gray@csiro.au

Phone: +61 2 9372 4642 Fax: +61 2 9372 4310
All other Enquiries to: radio-school@atnf.csiro.au

Cancellation policy: Any cancellation must be in writing/fax to the above address. Cancellation one week or more prior to workshop incurs a $25 cancellation fee. Thereafter, no refunds can be given. Registration can be transferred to another participant from the same school without cost or penalty.

Please consider this form a tax invoice once you have paid. ABN: 4167 871 19230