Copy the text below into a new email, complete it and send it to info@esperanto.org.au with the subject line “Congress 2024 registration”.
Hello,
I wish to register for the Australian Esperanto Congress
and Summer School in Ballarat, January 2024. Below are my details.
PERSONAL DETAILS
1. First name: ___________________
2. Family name: ___________________
3. Address: ______________________________________
4. Telephone number(s) (inc. area code): ___________________
5. Email address: ___________________
6. I am a full-time student at: ___________________ (Leave empty if it doesn't apply)
7. Special dietary requirements (if applicable): ___________________
8. I intend to participate in the following course (delete those that don't apply):
Intermediate / Advanced
9. My contribution to the program: ______________________________________
(* lecture, short talk, musical performance, etc, if you would like to)
10. I consent to the following details being included in the “Congress booklet”
(delete those that don't apply):
Name, Address, Phone number, Email address
11. Dates: ___/01/2024 until ___/01/2024
12. Accommodation:
(Delete the line that doesn't apply)
- I will be staying at Federation University
- I will organise my own accommodation
13. Payment:
(Delete the lines that don't apply)
a. Registration + 9 nights' accommodation + all meals: $1618 / $1518 (stud.)
b. Registration + accommodation + 3 meals per day: $145 / $135 (stud.) x __ days = $___
c. Day visitor (inc. registration) + 2 meals: $67 / $57 (stud.) x __ days = $___
d. Day visitor (inc. registration) without meals: $30 / $20 (stud.) x __ days = $___
+ I will be eating at the banquet: $36
14. Method of payment (delete those that don't apply):
- Cheque/money order posted to AEA
- Credit card via PayPal (on the website)
- Direct deposit into the AEA bank account
a. Date I transferred funds to AEA bank account (if applicable): ___/___/___
b. Reference I used to transfer funds to AEA bank account (if applicable):
___________________