1. Your Name*

2. Organisation

3. Phone No*

4. Email

5. Fax

6. Address (For posting receipt)

7. Guest 1

8. Guest 2

9. Guest 3

10. Are you an FIAQ member?

Yes No

Ticket prices

11. Please select from the following ticket prices according to Membership Status

FIAQ Membership $70.00 per ticket (plus GST)
Non Membership - $120.00 per ticket (plus GST)

12. Any comments