Tickets for the 2011 Healthy Waterways Awards
Wednesday 22 June 2011

Please note: Fields marked with an asterisk are compulsory

 Personal Details
Title


* First Name

* Last Name

* Organisation

Job Title

* Address Line 1

Address Line 2

Address Line 3

* Suburb

State

Postcode

* Phone

Please include area code.

Fax

Please include area code.

* Email

 Special Requirements
Dietary Requirements

(e.g. vegetarian, diabetic)

Special Seating Requirements

 How did you hear about the Healthy Waterways Awards?
* Heard About Via

 Sponsor
 Colleague
 Friend/Partner
 Media (Radio/TV/Newspaper)
 Internet
 Other (please specify below)

 Ticketing
* Ticket Type

 Awards Ticket (GST Included) ($115.00)
 Complimentary

If selecting Complimentary Ticket, please provide further details (e.g. sponsor, finalist, judge, special invitation) in the following field.

Please note: A limited number of key partners would have received an invitation to the Awards as a complimentary guest.

 Terms and Conditions

All amounts quoted are in Australian Dollars (AUD).
All payments must be in Australian Dollars (AUD).
Except where indicated, all amounts are inclusive of Australian Goods and Services Tax (GST).
Your confirmation of booking is also a tax invoice.

IMPORTANT: Credit card charges will appear on your statement as a payment to International WaterForum.

Cancellation Policy
All cancellations and amendments must be received in writing. Cancellations received prior to Friday 10th June will receive a full refund of the ticket price less a $15 administration fee. Any cancellations made after this date will not be eligible for a refund. Regardless of payment method refunds can ONLY be made by cheque.

I have read and agreed to the Terms and Conditions

 Payment Method
* Preferred Payment Method

 Secure Online Payment (Credit Card)
 Cheque
 Direct Deposit
 Complimentary Ticket

On behalf of Healthy Waterways, the International WaterCentre Pty Ltd is acting as the managing agent for ticket payments to the 2011 Healthy Waterways Awards.

International Water Centre Pty Ltd
ABN: 58 115 590 255

Attn: Carla Mathisen
PO Box 10907
Adelaide Street
Brisbane QLD 4000

E: hwwawards@healthywaterways.org