Visitors' Program - Registration Form

Please use one form per adult registration for the Visitors' Program. Photocopy extra forms as needed.
(Members of Assembly should NOT use this form)

Personal Details:

Title _____________________                      Preferred First Name ________________________________________




Surname ___________________________________________________________________________________




Postal Address ______________________________________________________________________________


_________________________________________________________ Postcode _________________________




Phone (daytime) ________________________________  (after hours) __________________________________





Age:           Under 25                    Over 25



Accompanying Persons:


Will you be accompained by a spouse, partner, friend or child?                                           Yes           No



Are they a member of the Assembly meeting?                                                                          Yes          No



Their Name/s (and ages of children) ______________________________________________________________


Accommodation:


Where will you be staying during the week of Assembly?

  with family/friends

  in one of the University colleges (please pre-book thru Chris Johnson on 03 9251 5209


  at a nearby motel/accommodation facility

       Please specify: _____________________________________________________________________________


  other - give details: __________________________________________________________________________



Arrival Details:

How will you be arriving into Melbourne?


  I would appreciate an arrival transfer. I will be arriving at (tick one):

        Tullamarine Airport                   Spencer St Railway Station                   Franklin St Coach Terminal


      on (date) _________________________________    at (time) ________________________________________
      
      from (origin) ______________________________


  by private transport/vehicle


  other: please specify all necessary details: _______________________________________________________



Departure Details:


  I would appreciate a departure transfer. I will be departing from (tick one):

        Tullamarine Airport                  Spencer St Railway Station                     Franklin St Coach Terminal

      I need to be at the departure terminal on Sunday 19th July by (time): ____________________________________


Special Requirments:
(do you have any special requirements you would like us to consider? Eg dietary, mobility issues)


____________________________________________________________________________________________


____________________________________________________________________________________________






Payment:
(excluding airfares, accommodation, lunch and optional tours)

$210 per adult

$ 140 per child


  Enclosed is my cheque (made payable to: The Uniting Church Tenth Assembly) for the amount of $ ___________


  Please debit my                Visa            Mastercard              Bankcard              for the amount of $ ___________


with card number:                 ___________ / ___________ / ___________ / ___________

and expiry date:                     __________ / ____________ 


Cardholder's Name _________________________________    Signature of cardholder ______________________



Cancellation Policy:
Cancellation requests be made in writing, with each request considered on a case-by-case basis.



Signature:  ______________________________________________       Date  _____________________________


          

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