Mineral Systems - Mt Isa - Workshop - Registration

Please complete all fields marked with an asterisk. One registration per person.

On completion of the form you will be directed to the payment page.

*Recommended browser - Google Chrome*

Email Address *

Title *

Given Name *

Surname *

Delegate Type *

Student ID please upload a copy of your student ID

Tuesday 16 May - Social Event * The Alfresco Deck, Mt Isa Hotel

Tuesday 16 May - Technical Sessions * fees are per session

Wednesday 17 May - Technical Sessions * Fees are per session

Thursday 18 May - Field Trip * $165 per person You are only able to attend the field trip if you attend a session on one of the previous days

Dietary Requirements Please detail

Address Details

Affiliation or Company Name * Please provide name in full, no acronyms

Address Line 1 * Billing address preferred

Address Line 2 If applicable

Suburb/City *

State/Province *

Postcode/Zip Code *

Country/Region/Economy

Mobile Phone *

Emergency Contact Details

Emergency Contact * Name

Emergency Contact Mobile or Office *

Emergency Contact Relationship to You *

Please review the information you have provided and the cancellation policy before submitting your registration.