Registration

Delegates Registration Form

* fields are mandatory
Delegate details
Title: * Kindly provide details as per passport
Given name: * Nationality: *
Surname: * Passport No.:
Date of birth: Country of issuance: *
Organisation: Expiry date:
Position:
Address1: *
Address2: *
City: * State: *
Postcode: * Country: *
Day time contact number: * Phone (house):
Fax: Mobile:
Email:
Special dietary Meal: Vegetarian  No Beef  No Pork  
Others 
Notes: This arrangement is throughout the whole convention
Remarks:
Accommodation: Please tick the box if accommodation is required.


Copyright 2005 The Australian Hokien Association. All rights reserved.