ASoSS 2012

Registration (Early Bird - before 1^st March)	$220
Full Registration	$250
Conference Dinner	$75

Registration fees include lunches. The dinner will be held on Thursday evening at Mures Upper Deck, a seafood restaurant on the Hobart waterfront. Payment is by cheque, bank draft or credit card. After filling in the registration form you will directed to a payment form which can be faxed, scanned-and-emailed, or posted (snail mail!) back to us to complete payment.

Payment forms should be faxed to: +61 (0)3 6226 2410
Or emailed to: supersciencefellows@gmail.com

Please enter your name and contact details below:

Title:

First Name: Initial: Surname:

Affiliation:

Mailing Address:

        Line 1:
        Line 2:
        Line 3:
        Town/Suburb:
        Post Code:
        Country:

        Contact Phone Number:
        Mobile Phone Number:
        Fax Number:
        Email Address:

        For Super Science Fellows presenting at the conference, please select yes from the drop-down box below.
        Talks will be around 30 minutes duration including questions and should introduce your work to the wider audience.

        Please include the title of your presentation in the box below.
        Abstracts may be submitted now via this form, or by email at a later date.
        The deadline for abstract submissions is 21^st March 2012.

Talk Title

Talk Abstract

Will you be attending the conference dinner?

Number of additional guests?

Do you have any dietary preferences/requirements?