Surname: ............................................................... Title: ..........

First name: ...............................................................

Address: ...............................................................

...............................................................

Country: ...............................................................

Early registration fee is enclosed:

Corporate $400 ............

Normal $350 ............

Not in full-time employment $300 ............

Early registration will be paid before June 15th ............

I intend to register in July ............

Indicate here if you require accommodation at Mirumbeena Resort Motel. Please include a deposit equivalent to the cost of one nights accommodation. The following rates include a Northern Territory government tax of 5%.

Single standard motel unit $90.30 per night ............

Double/twin/triple standard motel unit $97.65 per night ............

Single deluxe motel unit $110.25 per night ............

Double deluxe motel unit (up to four people) $118.65 per night ............

Townhouse unit (not shared) $156.45 per night ............

Townhouse unit (shared, two people) $78.23 p/p per night ............

Townhouse unit (shared, three people) $52.15 p/p per night ............

Townhouse unit (shared, four people) $39.11 p/p per night ............

Please indicate the nights for which you require accommodation:

23/24 July ............ 24/25 July ............

25/26 July ............ 26/27 July ............

27/28 July ............

If you require airport transfers please indicate:

Day and date of arrival ............ Day and date of departure ...........

Time of arrival ............ Time of departure ............

Airline service ............ Airline service ............

Flight number ............ Flight number ............

Small tour groups of around 10 people will be able to visit selected Aboriginal

community initiatives in the Top End. Please indicate if you would like further information:

Symposium tour ............

Registration ............

Accommodation ............

Symposium tour ............

Total ............

Please make cheques payable in Australian dollars to '1997 Fulbright symposium'.

We can debit Visa, Bankcard and Mastercard Accounts:

Card no l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l

Card expiry date ...................................... 19 .........

Cardholder's signature ...............................................................

To register send this form to: