Registration has now closed.

Please complete a separate registration form for each delegate. Registration fees are $190 (Regular) and $95 (Student) - includes membership fee.

PERSONAL DETAILS

Surname
First Name	(to appear on badge)
Title	Ms Mrs Mr Dr Prof A/Prof
Institution
Address
State
Postcode
Country
Email
Fax
Tel.

TALK / POSTER DETAILS

Each Delegate may request to give one talk and / or display one poster. Talk slots are 15 minutes. Posters will be on display in the area where morning teas and coffees are held. There will be no scheduled poster session. All talks given by students will be eligible for the student prize. The deadline for abstracts is Aug 7 2009.

Do you wish to present a talk?		Do you wish to display a poster?
yes no		yes no

CATEGORY OF REGISTRATION

Please select registration type from the menus below either as a Current Member or as a lapsed/new member (Note: All memberships lapsed at the end of 2008, so you must have renewed your membership in 2009 to be a Current Member). The conference dinner is included in the registration. Current members: (Select) Regular registration = $150 Student registration = $75 Lapsed / New member: (Select) Regular registration + membership = $190 Student registration + membership = $95

PAYMENT OPTIONS

Please indicate which payment option from below you have chosen. You will need to organise payments separately to this online conference registration so please make note of the relevant details before you press SUBMIT. A receipt will be provided at the conference. Please email the treasurer for further details or queries about payment.

Option 1 (Bank transfer) Payment can be made via a direct transfer to the society's account using your own online banking arrangements. Bank: National Australia Bank Name: Australasian Evolution Society ANU BSB: 082-976 Account number: 83-192-7659 Reference field: (Please insert your name)   Option 2 (Credit card) A secure online credit card payment service is provided by Paymate. Please make note of the amount due and follow the link after you click 'Submit' below - a processing fee will be charged for this service (3% + $0.50).   Option 3 (Send cheque) If you want to pay by cheque, please make it payable to the Australasian Evolution Society ANU and mail it with a hardcopy of your form: Australasian Evolution Society Building 116 School of Botany and Zoology The Australian National University Canberra ACT 0200.