32ACCMCC: Registration

Registration


Personal details
Title
Family name
Given name/s
Preferred name for Nametag
Affiliation for Nametag
Street address
City / Town / Suburb
State (if Australian)
Postcode
State / Country: (If not Australia)
Email address
Phone number
Fax number
Do you intend to stay at University College?	Yes
	No
How many conference dinner tickets in addition to the one included in the registration would you like? $50 per ticket.
How many excursion tickets (total) would you like? $60 per ticket.

Contributed talk
Do you wish to offer a short contributed talk?
	Yes (please insert title below)
	No
Title (if known)

Student talks
There is a CMSA Student Prize for the best student talk at ACCMCC.
	Yes, I am a student and I will be giving a talk at ACCMCC and I wish to be considered for the CMSA Student Prize
	No

Arrival and departure details
Arrival details (if known)
Date:
Flight:
Departure details (if known)
Date:
Flight:

CMSA Inc. Life Membership
CMSA Council Life Membership (optional) includes benefits of CMSA membership and reduced ACCMCC conference fees at future meetings.
Do you wish to be considered for CMSA life membership?
	Yes (please complete the fields below)
	No
Position
Affiliation
Years of involvement	with combinational mathematics / computing

Payment
Important: To complete your registration complete the payment form, print and fax to: +61 3 479 8529 (attention: Irene Goodwin) or mail to: Irene Goodwin, Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand.