First Name
Name of delegate attending
Last Name

Organisation

Position

E - Mail

Phone

Payment Options
Cost to attend MediaSmart is $595.00(plus GST) per person. Please note payment terms are strictly 14 days. Places will only be confirmed once payment has been recieved.

Credit Card
If paying by credit card please indicate what card type you will be using. Please note a 4.51% fee will be added for all AMEX transactions. You will be contacted by phone for credit card details.

Contact for Invoicing
An invoice will be sent on completion of Registration Form. Please supply email address of person resposible for payment.


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