Registration Form 
Web Accessibility Workshop - Canberra
 Tuesday 31st May 2005, 9am-5pm
National Library of Australia, Parkes Place, Parkes
Please complete this form, then print it out and mail or fax with your payment to:  

Web Accessibility
National Information & Library Service
(A subsidiary of RBS.RVIB.VAF Ltd formerly know as Royal Blind Society of NSW, Royal Victorian Institute for the Blind and Vision Australia Foundation)
454 Glenferrie Road, Kooyong VIC 3144,
Fax: 03 9864 9370; Phone: 03 9864 9600

The National Information & Library Service may use your details to contact you in future about Web accessibility issues. If you do not want to receive such information please tick the Box:

|__| - I do not want to be contacted about other Web accessibility issues after this Workshop 

Attendee's Name:		

Position Title:		

Company/Organisation:		

Address:	………………………………………………………

	………………………………………………………

Phone (W)………………………………Mobile	

Fax: 		

Email:		

Web address of the site you maintain or are involved with  
(to assist in planning for the session)

URL:   	http://	

NB. Please complete one registration form per attendee.

Enquiries:	Tania Conlan Ph 03 9864 9249

Tax Invoice
National Information and Library Service
ABN:  73 094 583 874; ACN:  094 583 874

Web Accessibility
National Information & Library Service
(A subsidiary of RBS.RVIB.VAF Ltd formerly know as Royal Blind Society of NSW, Royal Victorian Institute for the Blind and Vision Australia Foundation)
454 Glenferrie Road,
Kooyong VIC 3144,
Fax: 03 9864 9370; Phone: 03 9864 9600

Invoice Date:	13th April 2005
Event:	Web Accessibility Workshop, Canberra - 31st May 2005

Attendee Name:	……………………………………………………………….

Company/Organisation:   …………………………………………………………

Registration Fee:	$522.50 including GST ($47.50)
AIMIA Members:	$495.00 including GST ($45.00) 

AIMIA Membership number: ……………………………………

1.	I enclose a Cheque for $522.50 / $495.00 payable to National Information & Library Service 

2.	Please charge $522.50 / $495.00 to my   Bankcard    VISA    MasterCard  
[NB. AMEX/Diners are NOT accepted]

Card Number (16 digits):

Expiry Date:	|__|__|  |__|__|  

	Name on Card:		

	Signature:		

I have read and understand the registration, cancellation, and refund conditions available on the web site and agree to abide by their terms.

Name:		 ______________________________

Signature	_______________________________

Date:		 __ __/__ __/ __ __

Workshop details are available from: http://www.nils.org.au/ais/
NOTE: Please return your Registration Form by fax asap.
Your application will be finalised when payment is received.