Mail the form with payment to: ASOR, Harry Gielewski, 28 Kennedy St, Reservoir Vic 3073

Or fax to: Kaye Marion at RMIT, Fax: (03) 9660-2454, Email:k.marion@rmit.edu.au

Closing date for registration: Monday 2^nd July

Full NAME: ________________________________________________________

Preferred first name: ___________________________ TITLE: _____________

ADDRESS: ________________________________________________________

______________________________________________________________

______________________________________________________________

Phone:___________________ Email:_________________________________________

Circle as appropriate:

Find enclosed a cheque for $___________ payable to ASOR Inc.

or charge to BANKCARD MASTERCARD VISA

Number:______________________________________________________

Expiry date: ____/_______

Name on card: _________________________________________________

Signature: _______________________________________ Date: _____________